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Home My WebLink About16233-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15985 Date Julx 22, 1987 THIS CERTIFIES that the building ...... .D.E.C..K. AD. D..I .T.I.O..N .......................... Location of Property 725 Bailey Avenue Greenport, New York House No. Street Hamlet County Ta× Map No. lO00 Section . . .0.3.4 ...... Block . . 9.~ ........... Lot .... i. [ ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated J u 1 y 1 5, 1 9 8 7 . pursuant to which Building Permit No. 1 6 2 .3 3 Z dated ....... ?.u. 1. y...1.5. ,...I .9.8. 7. ......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 ......... BECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to ROBERT WORRELL ..................... i .................... of the aforesaid building. Suffolk County Department of Health Approval ........... ~ ./.~ ............................ N/A UNDERWRITERS CERTIFICATE NO .................................................. PLUMBER8 CERTIFICATION DATED: Building Inspector Rev. 1/81 FOB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NE 16233 Z pursuant to application ~atecl ............... .~ ............... , Building Inspector. and approved by the Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ,,, ~mmmm,mm to the Building Inspec- tor 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 topograpP;ic featu res. 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 installa- tions, 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 "pm-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling. $25.0.0, Accessory.ISi0.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50 .. 00 3. Copy of certificate of occupancy $ 5.00, over .5 :Fears $]0.00 4.Vacant Land C.O. $ 20.00 5 .Updated C.O. $ 50.00 Date .... .3.u, ly..1.5.,..].9.8.7 ......... New C OhS truct ion..~.... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 7.25 Bail. y. Avenu. e Greenport, N.Y. Houee No, Street Hamlet ROBERT WORRELL Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section 034 Block 0.4 Lot. 1 ! Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. 16233Z Date of Permit 7./. !5./.8.7. .Applicant Robert Worrell n/a n/a Health Dept. Approval ........................ Labor Dept. Approval ........................ n/a n/a Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... X.X. ............... Fee Submitted $... 2.5. ,, 0.0. ..................... Construction on above described building and permit meets all applicable codes and regulations. Rev, 10-10-78 Applicant ....... l~(~[~ ~'~ '~f f ............................... UNDATION (1st) UNDATION ( 2nd ) UGH FRAME & ?LUMBING SULATION PER N. Y. STATE ENERGY CODE TION~L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FO~.INDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST [ ]ROUGH PLBG. []FOUNDATION 2ND [ ]INSULATION []FRAMING [//] FINAL DATE .. /~/~?~*)~/~· ,NSP£CTOR ~ ~.~ f ./ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . .~. ~4.~./.ff.., 19 Approved .....,.~, /..~..., 19~. Pe~it No. Disapproved a/c ..................................... II ~/lltl ............................................... (Building Inspector) ! ~ TOWN 9F SOUTHOLD APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. This application must be completely filled in by typewriter or in ink and submitted 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 of property must be drawn on the diagram which is part of this appli- 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 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 {~ 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 Law% 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, b}tiId~.g~code, housing code, a~!td regulations, and to admit authorized inspectors ompremises and in_building for necesiT.~-.j[ .~.. ~~ ........... -. .... (Signature of applicant, or name, if a corporation) ·..4-z . ................. (mailing ad~ess ~' applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ................... L ........................................................... Name of owner of premises .... ~.; .~'?T .~. ! .... ,~..0, .,~.~, ,/-: ~ ........................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ,:/. (Name and title of corporate officer) Build.er'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 ................................... : .............. House Number Street County Tax Map No. 1000 Section .... .~ .,~. .......... Block.....'~. ............ Lot....ZX ....... ". .... Subdivision ...... .ff...~.~/..~: ....................... Filed Map No..3/.//~. ........ Lot../vJ.//~ .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~c~,'~'~;g L ~ ' b. Intended use and occupancy .... .t~... ,/.~t).~.4 iA'~.'-.~. ..17'7. ............ ................................. 3. Nature of work (check which {'pplicable): New Building . · ........ ~Additi ...... Alt~ation .... ,.,~ .... Repair .............. Removal .............. Demolition o.n. ~ther Wor9. :~.~.--..~3.~. .... I ~ (Description) 4. Estimated Cost ......... ' .............. ' .... Fee '~'.~O, (to be paid on filing this application) 5. If dwelling, number of dwellin~ ul~it, s ..... ~./ff? ..... Number of dwelling units on each floor ..... ~)./~'. ....... If garage, number of cars .... '~/.~. ....... t. ..................................... ~., ............... 6. If business, commercial or mixed gecupancy, specify natu_re, and extent of each type of use ... ~lfi,~.._.... ......... 7. Dimensions of existing stmctu?es, if any: Front .... .~. ~-~ .......Rear ....Z.~..' ...... Depth..~..~.' ......... Hetght .~. ............ Nu~hb.er of Stones ... ~ .................................................. D~menslons of same structure ~wth alterations or addmons Front ....~ .-q .... Rear .... ~.~. .......... Depth .... ~.1~, ~.~.~ .t~. :. {. Height .... ~ ................ Number of Stories .... .2. ................. 8. Dimensions of eh~ire n~ew~nst~ction: Front . .. Z.q J ........ Rear ... Z.~.' ........ Depth ...t .~.t. ......... 9. Slzeoflot:Front ...................... Rear ...... $ ............... Dellth ...[ ........... 10. Date of Purchase .... -~ .... .. & ................ N~me of Former Owner .. ir{,..~.~.../~,~..t, ....... . .... I I. Zone or use district in which p~emises are situated .... ~..~.4:f .h.~.~..~.~:~..~- ............................ , ... 12. Does proposed construction violate any zoning law, ordinance or regulation ~,~ ................ 13. Will lot be regraded ....t~....,t ................... Will excess f~ll be removed from premises: Yes 14. Name of Owner of premises . .~. t?(~.~.~.~. . .~O.~ .&.~. . ~ ~. Address ~l .g I. JF,'tC, . .. ~. . . .~ r. : . .. Phone No. .Zg'Z.7 ' J ~' q. /. ..... .... Name of Architect ' Address Phone No Name of Contractor .... ~, .................. Address ................... Phone No ................ 15. Is this property {JJated withinl.00 feet of a tidal wetland? * Yes ..... No .~.. · If yes, Southold Town T~ustees Permit may be required. · i , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dknensions from property lines. Give street and bloc ~ number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, ~ ! S.S COUNTY OF/..9 ..... ......... ............. (Name of individual signing contract) above named· being duly sworn, deposes and says that he is the applicant Notar · .. County~~ (Signature of applicant) ...... day He is the ......... ; .......................... -.:,. .......................... .~ .............. I (Contractor, agent, corporate officer, etc.) ~r ............ ot~ownars-r4tnd is duly authorized to perform or have performed the said work and to make and file this application; that all statements cogtained in this application are true to ~he best of his knowledge and belief; and that the work wi~l be performed in the manher set forth in the application filed iherewith. Sworn to before me this