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Home My WebLink About9938-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office SouthoJd, N.Y. Certificate Of Occupancy No. Z.9599 ........... Date ........... .July. 20 ............. 19.7.9 THIS CERTIFIES that the building ................................................ Location of Property .... . Ho~se No. ' ...... County Tax Map No. 1000 Section .1D8 ........ Block . ~. ............ Lot , ~...16 ........... Subdivision. G=een~=ta~. Ac~e~ .......... Filed Map No. 6fi09 .... Lot No. 12 ........... conforms substantially to the Application for Building Pemit heretofore f'ded in this office dated ....... Sept,.. ~ ~ ..... ,1¢8.. pursuant to wMch Building Pemit No..~9,~8Z ............... . ~ .............. 19 78., was issued, and conforms to all of the requirements dated . .Seg.~, · ~ ~.~. of the applicable provisions of the law. The occupancy for w~ch t~s certificate is issued is ......... ..... .a..'p~x~ge..o. ne. ~.am$$7..4~e[~&~g ........................................ The certificate is issued to .... fowner, of the aforesaid building. Suffolk County Department of Health Approval . UNDERWRITERS CERTIFICATE NO.~27880 .......................................... Rev 4/79 TOWN OF $OUTHO~.D BUILDING DEPART~EIqT' TOWN CLERK'S OFFICE sOuTH'OLD, N- Y. BUILDING PERMIT (THIS PERMI~ Must BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Da~e 5L~7- /'7 ~ Permission is hereby granted to: · .~.~/.~.,~.. ...... d ~. ~.~i.L....~ ~ , ,. ..~ . , , ~?: ..~ *~: ,: ,~; ..?:~ .,{,':? ,~,.~},~.,:~V~,,~..~...~.; ....... ,.,,, ................ ./.. ................. :~ ..~ppl~mtmn .~t~d ...;, ~.,.,.~ ;,~.~:~...,~ ,~:...~,,t.~,~.:.:~.~ i- 1,~. , and approved by the TOWN OF SOUTHOLD Building Delm~tment 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 ~ 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, ~ndustrial 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 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 ~and use $5.00 3. Copy of certificate of ~ccupancy $1.00 ~,~. /~ .? ~ . Date ............................. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ . _% ....................... Location Of Property .~/~ ............... ~.~..; .....~..~....>,.... '.~'"' .............. Owner Or Owners Of Property ~~.~.../.~..~...~...~..~.-../--~...~.-"~ .................................................... Subdivision (~--~.'/-~ .~...-~...'~.. ....... ~?..Lot No....(-.~ Block No.....~TT... ..... House 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 permit meets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ (sta~ or seal) Notary Public .................................... County TOWN OF SOUTHOLD OFFICE FIF BIIILDINr- IN~PEOTOR TOWN P-LERK'S OFFIOE c~OIITHOLD, N. Y. 11cj71 FO~ NO. ! TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Exomined ................................ ~ ......... proved ................. ..2%rm,t No. DJ$opproved o/c ..................... ~-.-.~.-.-......_._......-.... ....................... (Building Inspector) Application No...~...~ ~ APPLICATION FOR BUILDING PERMIT Dote ................. . .................... . .... 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 o~ areas, and giving o 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 application, 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 necessary inspections. ......... ~" (Signature of applicant, or name,,4r'ir a corporation) (A~ldress ;~ a~iicant~' ............................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~..J~...[...J~..~JA.~...~.~...~...~.......~...~.t .................................................................................................... If applic~t is o corporot~, s'u;~nature of duly authorized officer. (Name and title of corp~'te officer) Builder's License No ..................................................... Plumber's License No ...... ~/...7....~T....~... .................... Electrician's License No.....7.....~...~....~../.~.~.. .................... Other Trade's License No ............................................... Location of and on which p. oposed work will ~e done Map No'//~-~' ~:~' Lot No Municipality 2. State existing use and occupancy of premises and intended use 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) Estimated Cost ..... .............................. Fee .......................................................................................... (to be paid on filing this application) ~/v'~ ~'u ' 5. If dwelling, number of dwelling units ............................ ~ muer of dwelling units on each floor ............................ If garage, number of cars ................... ~...~f.~.. ............................................................................................................... 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 ............................ Numb/er of a Stories ................................ · . ,-,,................ 8. D,mens,ons of entire new construction: Front ........... ~....,...,..~r.. .......... Rear ......... Depth Height .................... Number of Stories . ~:~ · 9. Size of lot: Front ..... .J......~';.'. .......... .~...../...~.~...~....'~.. ........... Rear ..~...~..~..:..f~./.. ..................... Depth ~....~...~.~..~.~.. ............. 10. Date of Purchase ...~ ....... ~...~...~....../~.. ............................. Name of Former Owner ........................................................ 1 1. 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. ............ Wjll_e~ce~.;[ill be removed from premises: ( ) Yes (~'~ No I' ame f ne-of ~r ...... ~£N~R~ I~[~[~ ~, -'4~- / , 14. ~ o ow , ~ ~,,,i~ .................................................... Address ~..~...L~...~..f.,.a/~..~.:.~. Phone No.~...~..~..T.../...J~..~.~... Name of Architect .......................................................... Address ................................ Phone No ....................... Name of Contractor ~[l~t~ll, ~[~ ~[~' Ad res .~..~.~...~../..~-- Phone ........................ ............................................................ d s~Y. ..... ~..~.....~,... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW X, ORI~_ · .~ ~ c c COUNTY OF .... ~.~ .~..z.-.a...~...~. ......... ~o.~ ...... ~...~...~....~...~....~: ............... being duly sworn, deposes and says that he is the applicam (Name of individual signi~ contract) above named. He is the ......... ~'.~.~.~. .......................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 tk, a~ the work will be performed in the manner set fo~h in the application~iled therewith. Sworn tobef~e me this / /~ ~ moIo~ ~t ~c~;~ ..)~ ........ y..~..~ ........... ~uun~ ................................................... ~ ............................. ' /z/~'/~/~"/// ~~ (Signature of appli~nt) B~ Of tactl, ities fo~~ tT~fs,locati, o~ hav~ boon inspected by this dopal'tmon% and lo,ri8 ~.o be satisl'acto~'yJ~~ ~ Ohief of Oenoral Engln~$rtn~ HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT · ~ NEAREST WATER MAIN 4..~. MI +- ~' BOURSE OF WATER, PRIVATE ~/ PUBLIC ~ · N'SUFF. CO. TAXMAPDISTAOOOSECTION 108 BLOCK ~, LOT~./~ ~THERE ~E NO DWELLING~ WITHIN I00 FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON. ~ ~E WATER SUPPLY ~D SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE '~l~obin ~ ~ ~'~ mdwin, New York IISffi r~,>~ ~/~&~ g · -- MONUMFNT SE'~r SUBDIVISION MAP F/LFD IN i'HE OFFIC~ SUFFOAK COUNTY ON OCr. F, 1977 '~THE LOCA?'I~ O~WELL(W),$gPTIC TANK(ST)~ CESSPOOLS (CP)SHOWN HEREON ARE FROM FiELD OBSERVAT ONE AND OR DATA OBTAINED FROM OT~ERB~ SURVEY FOR GRFEIV BRI,~R' HOMES, INC. lOT NO. 12 " Gt?EENBt?IAR AC/?ES" AT MATTITUCI~ TOWN OF SOUTHO£D SUFFOLK COUNTY, NEW ¥OR~ AP/?I£ 16, 1979 DATE ,~UG. I0, 1978 SCALE: I" -' 401 NO. : 78-487 :~ YOUNG a YOUNG ALDEN W YOUNG,PROFESSIONAL ENGINEER AND LA~,D SURVEYOR N'/iS, LICENSE N0,~2845 HOWARD W YOUNG, LAND SURVEYOR NYS LICENSE NO 45895 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK COUNTY DEPARTt~E~T OF HEALTH ,~ERVICES FOR APPROVAL OF. CONSTRUCTION ONLY HEAl. TH DEPART MENT- DATA FOR APPROVAL TO CONSTRUCT OTHER THAN THO~E ~HOWN HEREON. I: MONUMENT SET ' -' ~UBDIVI$ION MAP F/LEO IN THE OFF/CE OF ~E CLERK SUFFOL~ COUNTY ON OC~ ~ 1977 AS FI~EN~ 6609. ',H-THELOCA~ION OFWELL(W)~$EPTIC TANK($T)&CE$SPOOLS (CP)SHOWN HEREON ARE FROM I~IELD OI~$ERVATfONS AND OR DATA OBTAINED FROM OT~ERS~ SURVEy FOR LOT NO, 12 ' GREEIVBRIAR ACRES" AT II~ATTITUCK TOWN OF SOUTHOLD SUFFOL~K COUNTY, NEW YOrK SCALE: 1' -- '~0~ NO. ~ ?~-4~7 ~ YOUNG a YOUNG ALDEN W YOUNG,PROFESSIONAL ENGINEER AND LAND SURVEYOR NYS LICENSE N0.12845 HOWARD W YOUNG, LAND SURVEYOR NYS LICENSE NO 45893 400 OSTRANDER AVENUE RIVERHEAD,NEW YORK