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Home My WebLink About9832-z FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9832 Z Permission is hereby granted to: Greenbrier Homes Inc. Fa ........ ~.~..t..z.A...a...~?.~....o..n...e...~.z.z..~.e..z...z..t.~ ................................................................ at premises located at .................. ~9~...ElJ~e]3...s...Lan~ ................................................................ Matt~tuck~ Ne~ York pursuant to application dated July ']0 19.~.., and approved by the Building Inspector. Fee $..~'.~ * ~..~ ........... 1000-108-3-5.14 Building Inspector FO~ NO. 6 TOWN OF SOUTHOLD Building Depo~tment Town Clerk~ Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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, 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 aT 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. Dote 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 ........................... New Building .................... Old or Pre-existing Buildlng ............................ Vacant Land ............................ Location Of Property . ./.... ........................................................................... Owner Or Owners Of Property ............ · .................... Subdivision ~~.~..?.~....~..~...~..~.'..~..~ ............. Lot No..~. ........ ~ ~/tIP'~No..~..~'~ ........ House No ............. -z ................................................................... Permit No.-/..~...../.~. ....... Date Of Permit .. Applicant ~,~~?'z~-~ /-/~/W~-~ Health Dept. Approval ............. ..~.......g~.~..£.?.5..~...~...Labor Dept. Approval ................................................ Underwriters Approva~ ............................................ g ........................................ 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 ............................................ (stamp or seal) Nata Pub,,c .................................... TOWN OF SOUTHOLD i'-IFFICE I"]F F::ILIILDING INSPECTOR TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 119'/1 TEL. ?_ ~a.- 7:5- FOR3~ NO, J. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI, Y. Approved ...... J.uly.......1.2 ................ 19~.~.... Permit No ......~..8.~..2..Z.. ................... (Building Inspector) Application No. ~)832 APPLICATION FOR BUILDING PERMIT Dote ........ , ....... ~/.~ .................... ~9.~.~.. 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 o[ areas, and giving a detailed description of layout ofproperty must be drown on the dlogram 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 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 appJicobie Laws, Ordinances 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 inspectio~,,.rA , GR[E6BRLAR ilUmLb.,.m~, ' ............ ~' (S'gnature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ~,~ ...-.....~d.~.~. ~ .................................................................................................................................... Name of owner of prem ses GREENBRIAR HOMES 11~. o f,c r. ..... ....... .... (Name and title of cor~rate officer) Builder's License No ..................................................... Plumber's License No ............ .'~.....~.~...:~..~'... ............... Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of and on wh ch ro osed work w be done Mo No' ~'~.~.. p o,p . p ......................................... Lot No ......................... Street and Number .... Z~./...-~......~..~.:../..Y~..*~....~.........~..,f~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 ........ ...~.....j~..~.~.~..~....~.....~...~...~....~...~.~.../....~.....~..~..~. ............................................ / 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... ~L Estimated Cost ................... ,,~,~..~.. .............................. Fee ~-~- ~'~ (Description) (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 O~/'~ 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 ............................ N. umber of Stories ................................ v .... o 5. o- r D 8. D~menslons of enhre new canstruchon: Front ..... ~... ........................... Rear ......................... epth ...~...~.. ............. Height .................... Number of Stories .......... (~....~,..,~-c.. ............................................................................................... 9. Size of lot: Front ......... ~'~"~ --' .'.~.../..~...:.~...~..~. ......................... Rear ..~.'.../.~..,....~...~,..~.~ --' ................ Depth ../..~...~.......,~...(q~...?.. ..... 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: ..... 4.~...~.. .......................................... 13. Will lot be regraded . ........ I~1: I~ll~ IIIllll --''~'~[N~m't~Vi~n~l~Sll~/be removed from premises:( ) Yes (~ No 14. Name of Owner of premises .................................................... Address ....................................................... t~..~:~ Name of Architect ........................................................ Address ................................ Phone No ....................... Name of Contractor EENiIRi II HOI i " . ............ ........................ . .................................... Address ..~...~..~.~.~.,'~..'~. Phone No .~...~..~./....~..~, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property fines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. J a~ STATE OF NEW '~lDgl~,,~ COUNTY OF .....~...~'._.~.~..~..~..~.- /~/~"~';¢/~"~' ~' ~& ~ bein~ duly sworn, deposes and says that he is the applicam ' (Name of individual signing cofftracf) above named. He is the ........ ~.~.~ ......................................... J ........................................................................................... (Controctor, agent, corporote officer, etc,) of soid owner or owners, ond is duly authorized to perform or have performed the soid work and to make ond file this opplicotion; thor o[I stotements containe& in~ this appl,icotion are'true to the'best of his knowledge ond belief; ond tho~ the work will be performed in the manner set fo~h in the opplicotion filed therewith, Sworn to before me this / ...... ............ .... .... -o - ~0. ~ ~to~ ~tre