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Home My WebLink About10084-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... ~ 9.~.7 ']. ........ Date .... THIS CERTIFIES that the building ................................................ Location of Property ....~.~0. House No. Street Hamlet County Tax Map No. ] 000 Section ...'10.~ ...... Block . .. :~ ........... Lot .... ~.,.~.. ......... Subdivision .C~'ee~3c~e~ .Ac~.e.~ ........... Fi]ed Map No..(~.0~...Lot No.. ~. .......... conforms substantially to the Application for Building Permit heretofore Fried in this office dated ·.. ,D09.~20~. 2.8. .... , 197..~.. pursuant to which Building Permit No .... .'l. O0(3.~.Z. .......... dated .. D.~a emb.~.. 28. ............ 19.7.~, was issued, and conforms to all of the requirements of the applicable provisions of the law. Tlae occupancy for which this certificate is issued is ......... ................. Priv. ate..One. F.~oil¥..Dw.el~ing ............................... The certificate is issued to .... G;c. een~.iar. Homes..Ino., .............................. (owner:~vOzx of the aforesaid building. Suffolk County Department of Health Approval .. 2./4 ~/~K) · · · ~3--80,-"152 · · · 'Ri · A',' '9'~t'l'a · UNDERWRITERS CERTIFICATE NO .......... I% '/4~66'~3 .............................. Building Inspector Rev 4/79 F01~ 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? 10084 Z Permission is hereby granted to: ' ........ ~.~. .~z~. /Z;.Z.z ~ /. ~. . . ~ Z. ~.~. . . . ~ c . ..... Z~...~.....~.z~...~ ................ ...~x,~z ~,...~.:.¥.. .............. 0 ~o ...~.~ x z~.~~~....~.~..r~~...~~.~ ~ r:. ~ ~..... ~ * ~~ ~/~.. ~.. ~.. ~..~.....~ ~ ~.. ~ ............... pursuont to ~pplic~tion doted ..~~...~....., 19~ ond opproved by the Buildin~ Inspector. Fee ~..~-~.,~.~ , ~ I ~ll~lng In~ector FOB,~ NO, S TOWN OF SOUTHOLO , Building Deportment 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, anti 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 opplicc~le. 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/ ~/-~ New Bqilding ................ Addition ................ Old or Pre-ex/sting Building ................ Vacant Land .............. Location Of Property ~.~`~-~//~```~```~``~`~```/~```~``~/`~``~`g~```~ ....................................... Owner Or Owners Of Property ..... ...~....~...~./~.~...~.......~......~...~....~...~/...~.. ......................................... Subdivision ..~..~.~'...~...~..'~"?..~....~.[.~..~..~ ......... Lot No.....~.. ...... Block No ............. House No..~ Permit No.~...~..~...~..~/...'~.... Date Of Permit ../.~..~/..?..~Applicant ....~....~..~,~...~../~..~..,~.~....,~..'~.......'~....~.~/..X/~' Health Dept. ^pproval ........ 2 ................................... Lobor Dapt. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate .......................................... Fee Submitted $ .................................... Applicant Sworn to before me this /~/ ................ day of ............................................ (stamp or sea~// Notary Public .................................... County THE 'NEW YORK BOLiqD OF FI *- ' ~-,~:-. , , · . ~ ~ ~ , ** RE.UNDERWRI e~:~-~:7%*~ ~ ;~2 ~:-~,,: :- a5 JOH~'STREET NEW YORK NEW y~n~e ~': ,-.February 6,, 1980 ~,..t~o..%.o.ft.' 05.~/;A-~,-~ THAT -- - ' .... : ~OL~ & H Fi?-.AI ~ -i"~L ~ re/~ I t,./6'& 1~0~ ~0. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,, N. Y. Exam,ned ........... Di~approv~d a/c ................................................. ~ ......................... ? ............. ........................................... ~'::L~ ................... ~ .......................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ 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 prem'ises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issoe O 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 necessary, inspections. ,...~.~..~..,~.~.:.~,...~.,.......,..~ ....... z..2........ ........ (Sign, ature of applicant, or name~K~Jf a corporation) ...~..~.~ .~: ~...~.. ~ .:....~ ~..,.~.,..~..~ ..z/....z,. ~ .,. ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... r2..~..z. ~...~z..~.~.~ .......................................................................................................................................... Name of owner of prem ses ....... ~[[~.~..~.~..R...~...~.M...~...I~..~., ................................................................................................... If appl~a~ is a corpora~ s~a~ure ~f~uty authorized officer. ...... (N~me ond title of cor~te officor) Builder's kicenso No ..................................................... ~b~'~ u~,~, ~o ...... ~.~.r~ ........................ ~.~'~ u~ ~o. ..~::..~ ..................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ..~'.~'......~...~../.~...~....~...~.....~..~L.'~...~.,.~-....X~...~...~./...~..~...~.~ ........ ......................... ~ , ;.:*.. -: .......... ~ ~'?~,~0 / ,,'~/D ~/'4.,,~/~ ,'~:~. . Munlc~pahty 2. State existing use and occupancy of premises and intende/~, se and occupancy of proposed construction: a. Exisiting use and occupancy ..... :~.'~...~ ........................................................... b. Intended use and occupancy ~?..~...-¢.~.~..~....-~...~ ~. 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) · ~, 000 0 ~ e ....~..:'.....T~...':':.: ................................................................. 4. Estimated Cost ...........~....~ ........... , .............................. F e (to be paid on filing this application) 5. If dwelling, number of dweWng 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 ~O" , ................................... Rear ............................ Depth ...--'~.. ................. I-[eight .................... Number of Stories ~/'/~' 9. Size of lot: Front ..... /~..~.,.~'O ! Rear /.~.2~0 / Depth .....~..~...~.. .................. 10. Dote of Purchase .......... ~..~..~..~.. ................................. Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ......... ~...~..../.-~..~...~..~ ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .....~..~. ............................................... 13. Will lot be regraded . ........ ..~...O. ........... Will excess fill be removed from premises: ( ) Yes 0~) No · GRtENBRIAR HO ES lNG. 14. Name of Owner of prem~ses .................................................... Address ...~...~'..~ ........... y .., Pho e No.~..-2:.~....-Z...~...~. Name of Architect ............................................................. Address ................................ Phone No ....................... ................................................ I~I~£[~R~I~ ~011~rr~ i~J~i ........... Name of Contractor Address~z..~.-.4~.~..~.~..~. Phone N ........................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end indicate oil set-back dimensions from property lines· Give street and block number or description according to deed, end show street names and indicate whether interior or corner lot. STATE OF NEW YORK· , ~S c COUNTY OF '. ......... f .... .~./.~..~....~..~.:..,~.......~..:..~...~..~..Z<.......<~...,~..: ........ .~...~....~....: ............. be ng duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ,,,,~,~Z~C~.~,,~,,,,~.~.~......~,~ ............................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ali statements contained in this application are true to the'best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ~ / ...... ~.~....~day of .................................. : ......... , 1 ........ /// ~ ~ ~ ~ n ~/~ ~//~//~/~ ~ '-~/ (Signature of opp~ant) MAIN COUNTY DEPARTMENT OF HIG~NL'I'H APPROVAL OF CONSTRUCTION ONLY DOt ROAD ( NYS. Rle. 25 ) SuRvEY FOR GREENBRIAR HOMES, /NO LO? NO. 3. "GREENBRIAR ACRES AT ~ATTITUCK ~OWN 0~ SOUTI-IO£D SUFFOLK COUNTY, NEW YORK DATE · AUG. SCALE: / "-- NO. : 78 - 400 OS'rGht,' ' ~ ROAD ( N ES. Rte. 2 ) MAIN suRvEY FOR ~OT ~0. ~, "G~EENBRIA~ AC~ES" D~C. ~, >A~F~__AJ..~_ RI, D. E~F. ~~~ AT MATTITUC~ DATE ~ AUG. 18, rm~ ~,v~e ~pos~i ~.na ~,~te~, suppiy TOWN QF SOUTHOLD SCALE: fneilil, ios for this 'tocaY.~on hava boen SuFFOL~ COUNTY, NEW YORK NO. : ~ ~ UNAUTHO~/ZEO ALTERATION OR ADDITION TO THIS GUARANTEED TO: Oh&e~ O~ GeDe~a[ ~Dg~D~eDt~ * ~' ~ :~¢ SURVEYOR~ iNKED SEAL OR EMBOSSED SEAL SHALL .DY .E COnSiDERED TO ,E ~ W~D TRUE CO.* ~F H~LTH DEPARTMENT-DATAFORAPPROVALTOCONSTRUCT -- AND ON HIS BEHALF TOTHE TITLE COMPANY, GOVERN- ~ ~li: l~2 .~'~ -~..~ ~SUFE CO, TAX MAP DI$~o SECTION /oB BLOCK ~LOT~.7 ~ HEREON, A~D TO THE ASSIGNEES OF THE LENDING ~. ~ ~3' ./;.~<~, OTHER THAN THOSE SHOWN HEREON. OWNE [ ,,~:~... ~ ~- m m 3 v~m mAl~ ~ v~l mM~ 4oo ~~~VENUE ~.~ ....... ,,,~. ~ ~ ~m m m~m~ m~m~ RIVERHEAD,NEWYORK~ : s~B~lVlSl~fl ~P ~1~ I~ r~g 0~1~ ~F r~g ~ OF ~ ~ AND LAND SURVEYOR NXS. LICENSE NO J2845 ' SUFFOLff COUntY ON OC~.~ I~77 ~S Fl~g N~ 6E~9. ~ -mm HOWARD W. YOUNG, LAND SURVEYOR ~THELOCATiON~WELL(W),3E~IC TANK(ST)SC~SP~LS(CP)BHOWN HEREON ~ m~ N.Y.S. LICENSE NO 4.5893 ', L.ot t:?OA D ( N.Y.S. Rte. 25 ) ,, MAIN SURVEY, FOR SUFFOMC COUNTY DEPARTMENT OF HEALTH SERVICES GREENBR/AR HO4,fES, //VC. rOT NO. 3, "GREENBRIAR ACRES" I~)R APPROVAL OF CONSTRUCTION ONLY AT /j//A~TT/TUC/(~ DATE . /JUG. E8,/.978 TOWN OF SOUTHOLD SCALE: l"--'~O' DATE l~)~ ~ n~- ~c~_ suFFoLi( COUNTY, NEW YORK NO. , 78- 525 · .~UNAU~NOI~IZED ALTERATION OR ADDITION TO THIS SURVEY, IS A VIOLATION O,F SECTION 7~09 OF THE APPROVED ' NEW YORK ~;TA:FE EOUCATllpN LAW ~-COPiE~: .07 THIS SURVEY NOT GEARtNG THE LAND , SURVEY.OR ~ INKED SEALFOR EMBOSSED SEAL SHALL NOT SE COI~SIDERED TO BE A VALID TRUE COPY ~'GUAR~NTE~ES NDICATED HEREON SHALL RUN ONLY TO i THE P~RGOI~ FOR WHOM T~IE SURVEY IS PREPAREO, HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT AND ON:HIS BEHALF TO 1'HE TITLE COMPANY, GOVERN- ,,~NEAREBT WATER MAIN '~FMI ~ ~'SOURS~[OFWATER~ PRIVATE /PUBLIC__ MENTA[L AGENCYAND LENDING INSTITUTION LISTED ,, ~-SUFF. CO, TAX MAP DIST."~,,eo SECTION/o.~..~_BLOCK 3 LOT"'~.'r REREOt~,ANb TO THE ASSIGNEES OF THE LENDING TO ADDJT ONAL NST TUTIONS OR SUBSEQUENT OTHER THAN THOSE SHOWN HEREON. ' OWNERS. WiLLCONFORM TO THE BTANOARDSOF~HE SUFFOLK COUNTY D,~A~MENT TO EXI~TIN~ STRUCTURE,S ARE FOR A SPECIFIC A~eEs,. ~54 Robin_Ct. , . i-- YOUNG YOUNG ' - , 400 OSTRANDER AVENUE Baldwin, New York !!5!~ TEL., ~/~ G . / ~ RIVERHEAD, NEW YORK m =MONUMENT SET ~m ALDEN W. YOUNG,PROFESSIONAL ENGINEER :~ EU~D/V/S/ON ~RP FI&ED IN T~g OFFICE OF ~g CAE~ OF AND LAND SURVEYOR N.~S. LICENSE N0.12845 SUFFOLK COUNTY ON OC~ ,X, 19~X AS FILE N~ 6609. HOWARD W. YOUNG, LAND SURVEYOR ( Rte. Z5 SU~LK COUNTY DEPARTMENT OF H~LTH SER~CES ~0:~ ~, ~'~~/~ AT ;~/~U~ DATE -AUG. 18, FOR APPROVAL OF CONSTRUCTION ONLY TOWN OF ~OU~O~ SCALE: /"~0' S~F~OL~ COUNTY, NEW YORK NO. = 78-5~ DATE . HS REF. NO .... ' ~ ~b~Ho~z[o AL~AT~O~ O~ AOOmO~ ~0 ~H~S SURVEY IS A VtOLA~ ON OF SECTION 720~ OFTHE NEW Y~RK STATE EDUCATION LAW, APPROVED ..... . ],, ,, ~ v ~ CO~ES OF THIS SURVEY NOT BEARING THE LAND SORV~YOR'S INKED~EAL OR EMBOSSED SEAL SHALL NOT ~E CONSIDEREO TO 8E A VALID TRUE COPY ~UA~ANTEES INDICATED HEREON SHALL RUN ONLYTO .... ~" "'~ THE ~RSON FOR WHOM THE SURVEY IS PREPARED, H~LTH DEPARTMENT"DATA FOR APPROVAL TO CONSTRUCT AND OH HiS 8EHAL~ TO THE TITLE COMPANY, GOVERN- ~NEARESTWATERMAIN~ML~ ~SOURSEOFWATER, PRtVATE~PuBLIC~ M:EN~AL AGENCYAND LENDING INSTITUTION LISTED ~SU~.CO. TAXMAPOST. x~eo 3ECTON~o8 BLOCK ~ LOT ~.~ HERE~N, AND TO THE ASSIGNEES OFTHE LENDING ~TH[RE ARE NO DWELLINGS' WiTHiN I00 FEET OF THIS PROPERTY ~NSTf~UTION. GUARANTEES ARE NOT TRANSFERABLE TO A~D;TIONAL iNSTITUTIONS OR SUBSEQUENT OTHER THAN THOSE SHOWN HEREON. ~E WATER suPPLYAND DEWAGE DISPOSAL SYSTEM FORTHI$ RESIDENCE ~DiD~ANCES SHOWN HEREON FROM PROPERTY LINES OF HEA~TH 9ERVICES. PURPOSE ANO AR~ NOT TO BE USED TO ESTABLISH APPLICANT, P~O~RTY L NES O~ FOR THE ERECTION OF FENCE~. A~E~SS', ''~ ', 1 ~0~ ~ ~0~ 4000STR~NOERgVENUE ~ I ~gL., '' RIVERHEAD, NEW YORK , ,, ,_l_, · ~O~E~ ~gr ALDEN W. YOUNG,PROFESSIONAL ENGINEER SUBOIVI~ION MAP F/LEO IN tHE OFFICE OF TH~ AND SURVEYOR N.~S. LICENSE N0.12845 ~/HOW~R~ w. YOU~, L~D SURV~YO~ '~A~ON~WELL(W),~E~ICT~K(eT)~C~LS(CP)SH~HEREON ~J' N.~S. LICENSE N0.45893 ARE,FROM FIELD OB~RVATION$ AND OR DATA OBTAINED FROM O~E~S~' ~ ~, , ~ CODES. NOT RESPONS~DLE FOR DESIGN OR CONSTRUCTION I