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Home My WebLink About9939-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BI~ILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9939 Z Permission is hereby granted to: ¢~.~.e.,~.z..~..~..~.,.~ ......... .~./~..~..e..~. ...... Z~. ~ · 'OltM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerk~ Office Sonthold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in ~te to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil 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 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 ~'//'~/h~ ~ ;7 Date ............. %x..,..::../...:.~.. ............. New Building ..... ~ ........ Old or Pre-existing Building ............................ Vacant Land// ............................ ........... Locotio~ Qf Property ...~ ............................................................ owner Or ~ners Of Rroperty ~~t~.~..~ ~ .~: ........... Subdivision ~~'..~:.....~.~..~..Lot No..../~..... Block No....~.. House No.,~ 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. ................ day of ............................................ (stamp or'seal) TEL. TOWN OF SnUTHOLD DFFICE OF' BUILD,NS TOWN CLERK'S OFFICE Application No. 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 of property must be drown 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 hove 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and irt buildings for necessary inspections. .._ BE~HBR[AR HOM~ i1~. ................ ~ ( 'g a re of applicant, or rOChe, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises GREENBRIAR HOMES INC. . ........................................................................... If appticarjt is a corporatg/~sig, nature of duly authorized officer. ...... (Name and title of cor~te officer) Builder's License No ..................................................... P'umber's Lice.se No ......... ~./.,,,7..:.~. ................. E,ectrJcia.'s 'icense No ....... Z~..:.~. .............. Other Trade's License No ............................................... Locat on of and on wh~h~_roposed work w /b~ done Mep No' Lot No Street and Number ~..~./,.~....~.,.~....J...'~.~....~..~....'.:~..~.....ii.~'~..~?..~..?.~iiill ............ Municipality State existing use and occupancy of premises and intended use and occupancy 0f proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. ~ntended use and occupancy ...~...~ ~ ........ 3, Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................. .... (Description) 4. Estimated Cost ..~.'...~./..~...~...~.: ~ .............................. 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 ............ .~.../...V'..~...: .................................................................................................................... 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 ..... c~ ............................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....~.~..C..~ ................. Rear....~.~ ................. Depth ........................ Height .................... Number of Stories ..................................................................................................................... ~. s~ of ~o~: ~o~ ...¢~. ............................................. ~e~ ........... ................ ~pth ...................... ........... ~.~ ....................................... Name of Former Owner ........................................................ 10, Date of Purchase ~.Zone o~ ~,~ d~,~r~c~ ~ which p~,~, ~ ,~d ....... ~<~ ............................................................... ~2. Does proposed canstrucfion violate any zoning law, ordinance or regulatiom ....... ~ ........................................... ~.w,~ ~o~ b~ ~egr~ded'. ........ ~...... ....... W,~,~.~"i~. b~ re~o~d f~o~ p~,~,: 14. Name of Owner of premises ........... : ........................................ Address .~..~....r.~Phone No ...................... Name of Architect .............................................................. Addre~ ................................ Phon~ No ~om~ of Co,~c~o~ ..~.~[~..~..~., ................ ~dd~,,,~<4.~.. ~ho,, No.~Z~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y 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 YORK., _ I S S COUNTY OF .~..~..~.~..~..~...~....~=. ........ f ' ..'.~...~.~...~......~,.,,..,4~,.~..,,~ ............................... being duly sworn, deposes and says that he is the applicon, (Nome of individual signing contracf) 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 make and file this application; that all statements contained in this applicoti6n are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application flied therewith. Sworn to. before me this //~'~ ... da,, of ......'~'..~..~', .~--f~.....'~..~:~ ..... 19...?. · ............... ........ .................. JANE FLATLE¥ NOTARY PUBLIC, State of New Yorl~ No, 52-46654~8, Suffolk County Commission ~xpires March 30, Werner L. Adel (B 16) BA 3-1 r e br ar omes Jun 85~ Robin Ct. B~lSwin, NewYork IISI0 "GP~B~IAR ~cREs AT m~TTITUC~" JOB # ~ (LO~ # ~l) LOCATIO_._____~N - E/S ELIJAH'S LANE, 2,000 FEET N/0 ~AIN ROAD. LO.T .SIZE - ONE ACRE 40~1~ SQ. FT. 213 x 186 STYLE - RANCH - 3 BEDROOMS, 2 FULL BATHS, LIVING ROOM, DINING ROOM, ' ~ EAT IN KITCHEN, FAMILY ROOM, LAUNDRY/MUD ROOM, FULL BASEM/~NT, 2 CAR ATTAC}{ED GARAGE. FEATURING - - POURED CONCRETE FOUNDATION. - BLUESTONE DRIVEWAY. - NATURAL CEDAR SHINGLES ALL AROUND. - 6" INSULATION IN CEILINGS; 3-1/2" IN EXTERIOR WALLS. - WHITE ALUMINUM WINDOWS WITH INSULATED GLASS AND SCREENS. - SLIDING GLASS DOOR WITH INSULATED GLASS AND SCREEN. - OIL - HOT WATER BASEBOARD HEATING. OAK FLOORS. 5 WALK-IN CLOSETS. BAY WINDOW IN KITCH]~N. - l# x 12 SUNDECK OFF FAMILY ROOM. - LAUNDRY/MUD ROOM ON FIRST FLOOR. - DISHWASHER; ELECTRIC RANGE. - FIREPLACE IN FAMILY ROOM. - CERAMIC TILED BATHS. - ~ASTER BEDROOM WITH PRIVATE BATH AND SHOWER. - ENTIRE PLOT GRADED AND SEEDED. FINANCING - CONVENTIONAL MORTGAGE AVAILABLE TO QUALIFIED STAGE OF CONSTRUCTION -. .............................. SELLING PRIC~E $ .................. PURCHASER. , CL. /v/u~ Room ' 2oLo"x 2+'-0" l~ to '~ /2 ~o" GA~AS~ TOTAL 2~2+~ GREENBRI~ HOME~, INC ~v~_.._~_.~_~_~ u~ ~. ~ ~'~'~.~ ~o ~OT N~ II " G~EENB~IAR ACRES" A~IL . ~ MATTITUCK ~ AU~ I0, ~sp~et~d by t,~is d(?~'tm(~t ~1~1~'~ fou~ SUFFOLK COUNTY, NEW YORK NO'. Y8-48~ NEW YORK STAT~ EDUCATION LAW ~ ~.w ~..~ FV~'~ ~ ~ ~ PROPERTY LINES OR FOR THE ERECTION OF FENCES ~ ~ tlAa~ln N~a, Vnr~11~l~ ~X--/~ I ~ ) V~I I~IP ~ ~/~l/~l~ 4000STRANDER~ENUE SUBDIVISION M~P FI~ED IN THE OFF/CE OF THE CLERK OF ~ I SUFFOLK COUNTY ON OC~ ~ 1977 AS FI~ENO 6609, AND LAN~ L~CENSE NO t2~45 ~ ~/ .ow~w ~OU~.L~DSU~V[~O~ bo! SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE/S DATE FOR APPROVAL OF CONSTRUCTION ONLY 'W. bot SURVEY FOR GREENBRiAR HOMES,/NC lOT NO. II . GREENBRIAR ACRES" AT MATTIFuCK TOWN OF SOUTHOLD SUFFOLK cOUNTY, NEW YORK *UNAL/THOR,ZED AL~ERATrON OR ADDII'iON TO THIS ~..~~ SURVEY IS A VIOLATION OF SECTION 7209 OF THE APPROVED N[W YORK STATE EDUCATION LAW H~LTH DEPARTMENT-DATA FORAPPEOVAL TO CONSTRUCT YME PERSON FOR WMQM THE SURVEY IS PREPARED Baldwin, NewYork[ _. . V~l i~1~ a ~11~1~ 4000STEA UE -- J IUUI~ ~ IUUI~U RIVERHEAD, NEW YORK BUBD/V/S/ON MAP P/LED /~ THE OFF/CE O~ THE CLEffK OF ALDEN W YOUNG, PROFESSIONAL ENGINEER ~THELOCATION~WELL(W),3EPTICT~K(ST)aC~SP~L3(CP)SHO~ HEREON J~ ~miHOWARD W YOUNG, LAND SURVEYOR A.EFROMFIELDOB~RVATIONSANDORDATAOBTAiNEDFRO~O1HERSl J~ ~ ~} N.YS LICENSE NO 45893