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Home My WebLink About9795-z FORM NO. 2 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) No. 9795 Z Permission is hereby granted to: ................. .G~.~'P.~..f,~r.~....ffg.~.e:~...~.~).~.t: ......... at premises located at .................... :)~..~l~zs.~..4:,e.~}e ........................................................................ ........................................................ ~'~.¢.~:L.¢;~o:,~,, ..~e.~:...~. .......................................................... ......... T..~.. ~.. ~%....~e e~b~,.i.a.~ ..Ac~.e s.,...l~p .. ~ .. f~6{l°~ ............................................................... pursuant to application dated ........... ~Te~9 ........ %~. ...................... , ]9......7~ and approved by the BuiJdJng Inspector. Fee $..~..., ............... Building Inspector 8-S0-53 FO~ NO. $ TOWN OF SOUTHOLD , 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 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, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(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, o 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 os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent formotio~ required to prepare o certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of oocuponcy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ................ Yaeont Lend .............. Location Of Property ..~../..~.....,~...~../,..~,~..~,..~..~,.....~,..~.,,.~.;.~.~....~,<~/..,~,.,~,,~:~ .......................................... Owner Or Owners Of Property (~'~'J'~/'"~ /'/'~ t Subdivision .~,~-~..~..J?~..'/.~.-.~..........~..~:..~.~.~..t~ ..........Lot No....~..,.... ~ No. ,~.~....~..?.. House No.....~..?..,~ Permit No...??....~.~.'..~....~. Dote Of Per,mit ..~./L.~....//..?..~l~..Applicont ............................... .J~.~....~.....~..~..~..../...~.,.d-, Health Dept. Approval ............................................ Vj Labor Dept. Approval ................................................ Underwriters Approval ............... ~-~---~-..~..~i ............... P. lonning 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) Notary Public ................................... Count,/ ~--'~C ~T~! ~ ~ ~ ~ TEL. '7~5-~660 TOWN OF SOUTHOLD OFFICE OF BUILDIN[~ INSPECTOR TOWN CLERK'S OFFICE SOLITHOLD, N. Y. 119'71 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........g.~ .e.......2..?. ............... 19.......7.8 Approved June 21 .7...8. 9795Z ........................................ , 19... Permit No ..................................... Disapproved a/c .................. '~"~'"'"~[i~ ............ j- ~ (Building Inspector) Application No ................................. APPLICATION FOR BUILDING PERMIT Date ........... ...~./.../..~..... ..................... , 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 premises, 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 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 who~e 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 bui dings, additions or a terations, or for remova 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__] '~"inspect'ign-s'--.4jL~..~,.'~ /~ (S'g at re of applicant, or name~'Rf o corporation) (Address of applicant) I1~-I c~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ............................................................................................................................. Name of owner of premises .................................................................................................................................................... if applicj6nt isa corporate, sigpature of duly authorized officer. ... ....... (Name and title of corp~r~'~e officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No. ~'~/~ Other Trade's License No ............................................... 1. Location of land on which p~roposed work will be done. Map No.: ...~.....(('..~.~..'~-- '~ ...................... Lot No.......~... .............. Street and Number ...~.~.~...~...~.~.~./~.~.~/~./.~./.~:~.~.~.'..~..../~...~..~:~..~.`..~..~..~7.:..T.../~?...~..~ 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 .~.~'~4/~:~'-~-~/~-~'~'-- .~.,...~./'~/ ~ 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) aA/£ "u ' . ........................... 5. If dwelling, number of dwelling units ............................ t'~ roper of dwelling units on each floor If garage, number of cars O4/~ 6. tf 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', ...: ...... ~'.~.~...~.. .............................. Rear ..... .~.~..~..,....~...~. .................... Depth .....,.~..../...'.~.. ................ 10. Date 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: ....... ..~.....~. ........................................ '/"~'['£~'IJ~JA~/1~1~I~1i~1. be removed from premises: (.~/~...~...~'.) Yes (X) No 13. Will lot be regraded . ........ i sI ...../~...~...z'..~...~.../.----'--Phone ] 4, Name of Owner of premises .................................................... Address No.~'~'~'/~''~ ...................... Name of Architect .............................................................. Address ................................ Phone No ....................... N of Contractor ............... Address .~,./~...~..~..,,~'~../.4../~,.", ,~¢ Phone No..;~...~...~...~./....~,...~... 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. £TATE OF NEW YORK, I ¢ ¢ / COUNTY OF ...~./.'.~.~.~.~.. ..........f~'~ 1 ..... ~..'.~.....~...~._.*~..~..........~..:..~...'~.?...~....~,......~ ............................... being duly sworn, deposes and says that he is the applicon, (Name of individual signing contract) above named. He is the ~'~7~ ~' (Contractor, agent, cor~rate officer, etc.), of said owner or owners, and is duly authorized to perform or have performed~he said work and to make and file this application; that all statements contained jn this application are true to thebest ~f h s knowledge and belief; and that the work will be performed in the manner set fo~h in the appli~atiop filed therewith. Sworn to b~fore me this / : : :....: ....... ...... ....................... NOTE: SUBDIVISION MAP FILED IN THE OFFI¢IZ OF THE CL£RK OF SUFFOLK COUNTYON 0¢~. Y~ 1977 AS MAP NO, ~09, IIV cO~ ~ SURVEY FOR ,~GREEIVBRIAI~ HOMES,/NC. ~£OT NO. 4 "GREENBRIAR ACRES" AT MATTITUCK TOWN OF SOUTHO£D SUFFOLK COUNTY, NEW YORK DATE MA Y 4, 1.978 SCALE: I"-- 40' HEALTH DEPARTMENT- DATA FOR APPROVAL TO CONSTRUCT ~ NEAREST WATER MAIN__4 MI,+ ~-SOUR~E OF WATER~ PRIVATE_~ PUBLIC ~ ~-$UFF. CO, TAX MAP DIST,/OGO GECTION /OE, BLOCK 3 LOT ,.~,8. ~TRERE ARE NO DWELLINGS'WITHIN I00 FEET OF THiS PROPERTY OTHE:R THAN THOSE SHOWN HEREON. .)(-THE ~/ATER SUPPLY AND SEWAGE D[SPO.'~AL SYSTEM FORTHIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES, ~ NEW YORK STATE EDUCATION LAY/ ~COPIES OF TH~S SURVEy NOT 8EARING THE LAND SURVEYOR*~ INKED SEAL OR EMSOSSED SEAL SHALL NOT BE COt~SIDERED TO SE A VALID TRUE DOPY NGUARANT[ES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED. ~R~,F~OM~IELD OB~RVATIONS AND OR DATA OBTAINED FROM OTHER3~~ 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK ~0~ § 7_- NO r6 .' SUSDIVI$10N MAP FILED 1N CLERK Of SUFFOLK COUNTY ON (Al. YS. /lie. JS) ~ NEAR~T WATER MAIN~MI.~ ~ BOURSE OF WATER' PRIVATE~PUBLiC ~ ~SU~.CO. TAXMAPDIS[/~$ECTI08 /OR.BLOCK 5 LOT 5.~ ~THEREARE NO DWELL~N~'~' WITHIN i00 FEET OF THIS PRO~TY OTHER THAN THOSE SHOWN HEREON,, ADDRESE · '~THE LOCATION OF WELI.(W),SEPTIC TAN K[~T) 8 CESSPOOL*9 (CP}SROWN HEREON Afl,E FROM ,FIELD OBSERVATIONS AND Off DATA OBTAINED FROM OTHERS. SURVEY FOR : TERREIVCE ~. MATTHEWS E~ REGINA B. MATTHEWS LOT ~10. 4 "GREENBRIAR ACRES" AT M~TTITUCt~ TOWN OF SOUTHOLD COUNTY, NEW YORK SUFFOLK ~ UNALITH~RR ZED ALTERATON OR ADDITION TO THIS SURVEY I~,A VIOLATION'OF SECTION 7209 OF THE NEW YOR~ STATE EDUCATION LAW ~'COPIES ~F THIS SURVEY NOT BEARING THE LAND 8UR¥~¥01;~'$ IRKED SEAL OR EMBOSSED SEAL SHALL NOT BE C~NSIDERED TO.BE A VALID TRUE COPY K~GUARAN'~E[B INDICATES HEREON SHALL RUN ONLY TO THE PERS~)N FOR WHOM THE SURVEY IS PREPARED, AND ON HER BEHALF TO,HE TITLE COMPANY, GOVERN- MENTal ~SENCYANO LENDING INSTITUTION LISTED HEREON,~ND TO THE A~SIGNEE$ OF THE LENOJNG INSTITUTI~)N, GUARANT~ES ARE NOT TRANSFERABLE TO ADOIT¢ONAL INSTITUTIONS OR SURSEOUENT OCT. 6, 1978 DATE SEPT./l, 1978 SCALE: I"-- 40' NO. ;'8- 572 YOUNG a YOUNG ALDEN W. YOUNG,PROFESSIONAL ENGINEER AND LAND SURVEYOR N Y.S. LICENSE NO 12845 HOWARD W. YOUNG, LAND SURVEYOR N.~$ LICENSE N0.45893 GUARANTEED TO: TERRENCE E. Et fi'ES/HA B. MATTNEY/S .RIVER',HEAD SAVINGS BANK USLI~ TIFLE I~SU~AN~ COMPANY OF GREENBPIAR HOMES, INC,