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Home My WebLink About23987-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24941 Date MARCH 19, 1997 THIS CERTIFIES that the building WOOD STOVE Location of Property 810 HOLBROOK LANE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 6 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 7, 1997 pursuant to which Building Permit No. 23987—Z dated MARCH 18, 1997 was issued, and conforms to all of the requirements of the applicable provisions of 'the law. The occupancy for which this certificate is issued is INSTALL WOOD BURNING STOVE AS APPLIED FOR. The certificate is issued to EDWARD & JUNE GIBSON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Buildjinspec%Or Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24942 Date MARCH 19, 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 810 HOLBROOK LANE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 6 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 7, 1997 pursuant to which Building Permit No. 23987—Z dated MARCH 19, 1997 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY GARAGE AS APPLIED FOR "AS BUILT" The certificate is issued to EDWARD & JUNE GIBSON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING — MARCH 14, 1997 PLUMBERS CERTIFICATION DATED N/A Hui ing Insp for Rev. 1/S1 FORM NO. t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 23987 Z Date .....r>rich..)Br.................................. 1981... Permission is hereby granted to: PATRICIA A. MOORE, ATTY a/c EDWARD h JUNE GIBSON ................................................................................ P.O. Boa 483 ................................................................................ Mattituck, N.Y. 11952 ................................................................................ to ......CONSTRUCT ACCESSORY GARAGE, INSTALL WOOD STOVE IN EXISTING ONE FAMILY DiIELLING .............. ................................................................ AND ERECT FENCE AS APPLIED FOR "AS BUILT" ................................................................................................................................................................ ................................................................................................................................................................ ................................................................................ ................................................................................ at premises located at .....b.1A..RQURQQK..LAN&......................................MATX1TUJ S.,..X..Y.................. County Tax Map No. 1000 Section ........1.13........... Block .......6............. Lot No. .......10.............. pursuant to application dated ....MARCH.7:.................................... 19..97., and approved by the Building Inspector. Fee 5..... 35.00 (Wood Stove) 35.00 (Acct' zGarage) 35.00 (Fence) 105.00 TOTAL FEES ........ .. . ..... . .......................... (2 CO'S REQUIRED) ildi Inspector Rev. 6/30/80 Form No. 6 LI -+11�i TOWN OF SOUTHOLD BUILDING DEPARTMENT 1997 ', TOWN HALL U 765-1802 T!'• s 1In PLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Cade Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - $20,00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00•, Commercial $15.00 Date . . . , , March 13: 1997 New Construction. . . . . . . . . . . Old Or Pre-existing Building. . .X, , ,wood ,stove 8k Location of Property. . . . .10. .Ho. . .lb. . .roo. . .Lane Matt ituA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House No, Street Hamlet )nwer or Owners of Property. . . , , , Edward Gibson and June Gibson . . , ounty Tax Map No 1000, Section. . , 113 . , , ,Block. . . . . . . 6. . . . . . . .Lot. . . . , 10 , , subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . 'ermit Of Permit. . . . . .Appl icant. , Edward;.&, June.Gibson, , , , , , , lealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . 'lanning Board Approval.. . . . . . . . . . . . I . . . . . . . . . . . request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . .X. . . . . ee Submitted: $. .. 25.00 . • . . . . . . . . . • . . . Patricia C. oore, attorney for Edward & June Gibs Form No. 6 - --� ,�-,t TOWN OF SOUTHOLD '',• p ��.. BUILDING DEPARTMENT TOWN HALL 765-1802 BLDC- 7RWr' OF ,.„IPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building, 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1 . Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . , , March 13: 1997 X Garage New Construction. . . . . . . . . . , Old Or Pre-existing Building. . . . . . . . . . . .. . . . . 810 Holbrook Lane Mck Locationof Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .attitu. . . . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . . Ed.wd .Gibo.n .and lune Gibson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. , , 113 , , ,Block. . . . . . . 6. . . . . . . .Lot. . . . . 1P Subdivision. ..p. .. . . . . . . . . . . . . . . . . . . . . . . . . . .`. . . .Filed Map . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit . .Date Of Permit. .37 f F .9 7 . . . . .Applicant. . Edward; &, June, Gibson, , , , , . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval.. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . X. . . . . Fee Submitted: $. . .2?;00 , , , , , ,, , , , , , , , , , , , , „ pp IC SnC�i Patricia! C. Moore, ANT, for•Edward• &• June•Gib 9 Ll 9 1/ Z PATRICIA C. MOORE Attorney at Law 315 Westphalia Road P.O.Box 483 Mattituck,New York 11952 Tel:(516)298-5629 Fax:(516)298-5664 March 13, 1997 BY HAND Town of Southold Building Department Southold Town Hall Main Road Southold, NY 11971 Re: Edward & June Gibson Premises: 810 Holbrook Lane, Mattituck, NY Dear Ladies/Gentlemen: Enclosed please find the following for the above referenced matter: 1. Applications for Certificate of Occupancy for the garage, wood stove and fence 2. Building Permit Applications for the garage, wood stove and fence 3. Three Consent to Inspection forms 4. Three copies of the survey 5. Check for payment of your fees 6. Installation instructions for the wood stove Please issue the Certificates of Occupancy at your earliest convenience. If you have any questions, or need anything else, please do not hestitate to contact me. Very truly yours, Patricia C. Moore PCM/mr Encls. : G0 VeC longi F ea e = {SHEET .; FA 224 Clearance UNPROTECTED SURFACES PROTECTED SURFACES Parallel Installations Comalnstallatiotu PanllelInstallatiota Coma butallations _ Stove Clearance Side Rev Coma Side Reu Coma s t No heat shields [A]20"(510 mm) 181 31"(190 mm) [C3 25"(640 mm) [D]10"(250 mm) [El WOW=) [F]12"(300 mm) Top exit,tear h.s.only [G120"(510 mm) [11]31"(790tnm) [11 25"(640 mm) [J] l0"=tnm) [K] 15"(360 mm)) [L]12"(300 mm) - Top exit,tear& [M]20"(510 mm) [N]IS"(460 mm) [0116"(410 mm) [P]10"(250 mm) [QI IO"(250 ttrm) [R]8"(200 mm) _ cattaaxor shields Rear exit.rurh.s.only [5120"(510 mm) [T7 18"(460 mm) NA [Ul 10"(250 mm) M 10"(2250 mm) NA Chimney Connector AN Installations All Installation Clearance No heat shields 27"(690 mm) 11"(280 mm) _ Connector hest shields 14"(360 mm) 6" (150mm) Froot Clearance to All InatalLnms Combustibles 48"(1220 mm) - FA 264 Clearance UNPROTECTED SURFACES PROTECTED SURFACES Parallel lnstallstiom Coma Installations Parallel la..anstl;. Coma Installations Stove Clearance Side Rear Coma Side Rear Coma No heat shields IA]24"(610 mm) B] 30"96600=) [C124"(610 tnm) iDl 12"(300 mm) M Ir(380 mm) IFI 12"(300 mm) i Top exit,seer h.s.only IG124"(610 mm) [H]30" ) [I) 21"(610 tma) IJl 12"(300 mm) fKjoM(380 mm) [L]12"(300`iron) Top exit.tear At [M]24"(610 mm) [N]15"(380 mm) [0]19"(480 am) [P]12"(300 tom) [Q] (300 mm) [R]10"(250 mm) oonaector shields Rear exit.tear h.s.only [S]24"(610 mm) M 15"(380 mm) NA [[1l 12"(300 mm) M 12"QW mm) NA Chimney Connector All Installatims All Installations Clearance No heat shields 26"(690 mm) 11"(280 tttm) Connector hest shields 11"(280 mm) 8" (20Dmm) FFront Clearance to Ali Installations CombtssU6les 48"(1224 mm) FA 288 Clearance, UNPROTECTED SURFACES PROTECTED SURFACES - Patallellnstauslions Coma htstallatims PanDd hutallatians Coma lnstalla¢ms Stove Clearance Side Rear Coma Side Rear Coma No but shields [A]23"(580,) B) 29"(740 mm) IC123"(580`tact) B1 18"(460 mm) [E]IS-(460 mm) [F]19"(480 mm) Top exit,tear ha.only [G]23"(580 mm) [H]29"(740 mm) [I) 23"(580 mm) IJl 18"(460 mm) M 18"(460 mm) [LI 19"(480 mm) Top exit,rear& IM]23"(580 mm) [N)I8"(460 mm) 10119"(480 mm) rPl 18"(460 mm) [Q]12"(300 mm) B1 15"(380 mm) coanaxor shields Rear exit,tear hs.only [S]23"(580 mm) M 18"(46D mm) NA M 18"(460 mm) M 12"(300 mm) NA Chimney Connector All Installations All IvstaIlatioos Clearance No heat shields 24"(610`tarn) 13"(330 mm) Cmnectorhest shields 13"(330mm) 7" (180mm) Front Clearance to All Installations Combustibles 48"(1220 tmn) etorl �, "'T'4,`'{9t-•5i"'s ^`n .' ^k#d 1 �tf -- ++ai.,xwe`i<i :e+mYs�p. _ y„ e e6lticationaand earariaea cludei! inth�stechaJheetAaie fopreliminaryplann ngpnrposea only. r eg�nnl g�insisllatio"n'�oonsuftyour»local out[iorized VetmontrCastings�/Conso118ated#Dutchweat'de31er �..,.- Page 26—Hearth Planning Guide H. -= w Federa Co sectio eate s ~ Minimum Wall Shield Requirements for Some Common Federal Convection Heater Installations ®The shaded area is not requited for rear exit installations vented directly into the chimney. FA224 FA264 FA288 , Spad 1'25 mm `tel"M� '� sped l"C73 mm) fmm a0ing T bm ediae T fmm alive 4S'0140mm) 45"(1140.) Sr(1470.) 36"(910 nvv) 36"(910.1 36"(910.) -}-Spad 1"(25 vm) � JLSpad I-= f . mmrlavr Sprd l"25 me) f,._� rnm a. 60"(t570 mm) Rear Wall Protection Rear Wall Protection Rear Wall Protection (ts tea) vs�) trm�e rmm a0vie rmm��; 31"(7543. 31•(790mm) 15"(890. 35•(890mm 3r(890 om 3x(890 mm 58•(1475 nun) Sr(1475 mmJ 5r(1475 Sr(1475mm) Sr(1475 mm) 58"(1475 mm) 14" 1r 19' IY IT Ir (350 nuv� 050.) (480mm� (480 mm) (460vnn� (460 mm) 45* 4.S" 54" Sr 53" 53• (1140vvn) (1140 nuv) (1770mm) (1370vvv) (1]50 mm) (1350mm) 36"(910mm) lr ]6"(915vm) 7r 36"(910 vun) 36' Alla mm) (91s mm) l (910 vvn) .Spad 1"p3 mm)rrtm flan .sp d r(]3®n)rim rbor .Spad 1"(73 mm)Lao rloa Wall Protection, 8" Corner Wall Protection, 10" Corner Wall Protection, 15" Corner Rear corners of stove 8"(200 mm)from the wall: rear Rear corers of stove 10"(250 mm)from the wart; rear Rear corners of stove IS"(380 mm)from the wart; rear and chimney connector hear shields attached to stow; and chimney connector hem shields mwched to aove; and chimney connector hear shields attached to stout; wall shields meet at corner wall shields meet at corner wall shields meet at corner T�(e.sped ceilon>�and'ctearences fhduded fn th th a _ prelim f n r : - . , Before.beginnYng a`ti�inatal�tlonrconeultyour local Seth _ Vermon .4Casttnga�l:o ed Hearth Planning Guide—Page 25 F c : e .e a Convec i n ea ars_ Y =� s ::EET Unprotected Surfaces Protected Surfaces 4 } } F A O �Ci O 7-00t � I MM O . p ❑ P41, LLL S NA IIIA Hearth Dimensions 127U Fireplace Installation Clearances B A B T U.S. CANADA A 16" (410 mm) 18" (4150 mm) B 6" (150 mm) V (150 mm) Model UA CanadaFA224 FA 264 FA 288 FA 224 38"X44" 40"X48" (1020mm X 1220mm) TrimSide Walls(S) 20" (510mm) 24"(610mm) 23" (580mm) FA 264 � Man 40"X60" (1020mm X 1520mm) (I) IZ" (300mm) 12" (300mm) 12" (300mm) FA 288 42"X62" 42X62" (1070mm X 1580mm) Mantel(hi) 20" (SiOmm) 20" (SIOmm) 20" (SIOmm) Minimum dimensions for noncombustible floor protection (Depth X Width). he 'pec Tl`catio6 anA+al��tances�AnWudedinithis recti. heat ansiorpreliminarylanningypurOlosesi,only Befoie beg"inningany instalinuc,n*consult your= ca7 authorized,Vermont�CastI-9VUo'UL11ida MMMhweat.'dealer Hearth Planning Guide—Page 27 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 8065084 BUREAU OF ELECTRICITY 1— 85 JOHN STREET, NEW YORK, NY 10098 Date MARCH 20,1997 Application No.on file 13541297/57 H 054419 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant nomad on the above application number in the premises of EDWARD & JUNE GIBSON, 810 HOLBROOK LANE, MATTITUCK, N.Y. in thefollowing location; PP Basement ❑ 1st Fl. ❑ 2nd Fl. GAR Section Block Lot was examined on MARCH 14,1997 and found to be in compliance with the National Electrical Code. FIXTUREACtfS SYYITCNES FIXTURES RANGES COOKING DICKS OPENS DISH WASHERS EX AUST FANS OUTLETS INCANDESCENTFLUORESCENTOTHERAMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMI. M.P. DRYERS FURNACE MOTORS FUTURE APMANCE FEEDERS SPECIAL RIC'PT TIME CLOCKS FELL UNIT HEATERS MUU60UTIET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO, A.W.G. AMT. AMR AML AMPS. TRANS. AMT. H.P. NO.OF FEET SYSTEMS AMT. WATTS SERVICE DISCONNICT NO.OF S E It G V I C E AUM AMT. ARV. TYPE l,e TN 1�R'TM 7,�31N 7 A'AW NO.. PER irc OFC C&D. NO.OF HRIG NO. NEUTRALS Of NEUTRAL OTHER APPARATUS *NO VISUAL DEFECTS. "An electrical survey has been made of the exposed electrical equipment in the premises indicated." "No obvious unsatisfactory condition was found. EDWARD & JUNE GIBSON L L P.O.BOX 663 MATTITUCK, NY, 11952 0040At MANAGER 11 Per This certificate must not be altered in any manner, return to the office of the Board if incorred. inspectors be identified;by t 'r credontiols. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. HOLBROOK RD. (Private) 71F= 19473 N83011.30"W 75' _ 90' �. FD CM. t /P FU s� O _ O I� � O cut O O O cz m m Q O = DRIVEWAY ti O b OVER 6.5't 0 F � UTILITY O 2�3MC POLE m SURVEY OF 'f64' rpP GE 24 2 DESCRIBED PROPERTY 'npp J SITUATE MATT/TUCK, TOWN OF SOUTHOLD o SUFFOLK CO., MY n b C Z � n CE[LAR � SURVEYED FOR THOMAS P ROCHE DONNA M. ROCHE szl J14'16£r q D;. 5 4 Bq IY� 5.i 3' !! 2 STORY m W000 FRAME m RES. - ,T n 2+' � qo m � _ GUARANTEED TO DEC W DFCK W THOMAS P ROCHE N V DONNA M. ROCHE 00 RIDGEWOOD SAV/NGS BANK, a° U 0 FIDELITY TITLE /NS. CO. m TOWN OF SOUTHOLD - N IP ON mi- RO W LINE j ~ 1$0 FRAME AREA = 24,265953 5.F S"FDor W 0.5571 AcresNp cQj- W APPROX, H W L S85025'12"E S760O8 39.2' 38,g 30 E IP =D = IRON PIPE FOUND CM FO CONCRETE MONUMENT FOUND HOWARDS BEACH of Guarantees indicated hete on shall w,- only to the person for whom the survey is prepared, and On his behafr to iho fill- cumpany, if li,fed hereon, [n!d kr fh� rs:.-tor or fhe h•nainn irslih�;:n, Cucrnntres at^ nr,t fmwirr;:i Ir 1, SURVEYED 4 JANUARY,1997 addilicnal institirtio:;; Cl s.lr.r.;u int a;u.,t SCALE I" c 40' ilnautLor;zcd ahrrnii,,n or add;lir•n 6> ;- SURVEYED BY xney is a v;•rlolkv. 'f ^:;lien T2f17 rr STANLEY J. 1SAKSEN, ✓R Thr Kew 1'004 iFd ff 1,ji^rl Low. PO BOX 294 NEW SUFFOLK, N Y, 11956 (516) 734- 5835 Cc p;^s or Iw, •,,.•,.,� mop nom; I•�;u iu� the Lcn;id 9iui:^y,• .is ^�:: <.;. s •.hell Y �. r. f / nCf be •nry. / 1 NSD L NY.SLNO 4927311 97RS/7 BOARD OF HEALTH ` . . . . . . 3 SETS OF PLANS . 1D FORM NO. 1 SURVEY . . . . . . . . . . TOWN OF SOUTHOLD CHECK - - • • • • • • • - IFY� 11 BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . : TOWN HALL p BLDG, c SOUTHOLD, N.Y. 11971 NOTIFY F.. TOW!-OF : - TEL.: 765-1802 CALL . . . . . . . . . . . . . . . . MAIL TO : Examined j. . . . . . . . . ., 19 T. 77 Approved . .3)1.1. . . . . . . . ., 194 ./. PpGermit No.,2. [V 27ia. . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . . March ,13,,, , , , , , , 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wii 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 str< or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this al: cation. 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 issued a Building Permit to the applicant. Such per 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 Occupa 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descril The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, an, admitauthorized inspectors on premises and in building for necessary inspections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Signature of applicant, or name, if a corporation) Patricia C. Moore, attorney for Edward & Ju Gibppn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Mailing address of applicant) P.O. Box 483, Mattituck, NY 11952 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builr Attorney for owners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . rdwarsl. Gibson. and. June. Gibson. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) ALL CONTRACTOR' S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 810 Holbrook Lane Mattituck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . : . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . 113. . . . . . . . . Block . . . 6. . . . . . . . . . . . . . Lot . . 10, , , . , , . , , , , Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed hlap No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . , Sarage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . Sara&? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteratio Repair Removal . . . . . . . . . . . . . . Demolition Other Work . ..garage. . . . . (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 . . ?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . 22.3 22.3Y 273ti 7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . ... . . . . . . . . . Height . . . . . . . . . . . . . . . Number ofStories . . . . . one. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . 75. ft:. . . . . . . . Rear . . . 7.. 1. ft:, .. . . _ . . , , Depth , approx., 322 ft. 10. Date of Purchase . . . . . . . . .1943. . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . Dora. . . . . I.. . . Gibson. . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . no . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . PP. . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes N 14. Name of Owner of premises Edward. &. June. GibsonAddress 810 Holbrook La._ . , Phone No. . 298-5172. . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . 15. Is this property located within 300 feet of a tidal wetland? *Yes . X. . . No . . . . . *If yes, Southold Town Trustees PermitPma b LOj DIAGRAMuired. Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions fro, t" ' 1'1 '."eal property lines. Give street and block number or description according to dee'iAii s�5o,v st g t names and indicate whethe interior or corner lot. See survey attached a CA) i CERT FICAI E rq�� 1 SJte � ! 'v a 1lNpFRWRITERSCERIifICA' E REQUIRED- MOST PF ALL CONSTF ICTION SHALL MEET THE REOUiREMEVTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, S.S COUNTY OF . . . .SUFFOLK . , . . . . . _ . . . Patricia, C... Moore. . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicar (Name of individual signing contract) above named. atto. . .r.ne. Y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hersthe . . . . . . . . . (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 th application; that all statements contained in this application are true to the best of his knowledge and belief;and that th work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . ./. '37-1',L. . . . . . . . . .day jT/•,L. . . . . . . . . .day of. . . Manch . . . . . . . . . . . .1 199.7. Notary PPuubbllliiicc,� .�S,Iuf'f�olk . . . . . . . . . . . . . . . . . . County LtARGA�A, K1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Notary Public,SiateoiK,o !".tk Patricia C. Moore (Signature of applican No.4982528 Oudified in Sullolk Counq CClnff(=iJ Expires Jun, 1 19.!7