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Home My WebLink About11980-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27989 Date: 10/03/01 THIS CERTIFIES that the building ACCESSORY Location of Property: 1185 MILL ROAD (HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 106 Block 9 Lot 8.4 Subdivision Filed Map NO. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 11, 1982 pursuant to which Building Permit No. 11980-Z dated OCTOBER 21, 1982 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 THREE CAR GARAGE AS APPLIED FOR. The certificate is issued to RALPH CARL & HELEN MARIE BERGEN, JR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTME~gT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION D~r~u N/A PENDING N/A lO/O2/Ol /// Signature Rev. 1/81 I~Ow-'M' NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMt:NT TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 11980 Z pursuant ,o application dated .~~..~.... ...... ../.../.. ......... , 19...~...4¢1nd approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 mJ APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to inspector with the following: for new building or new use: 1. Final survey of ~property with accurate location of all buildin~s, propertM~imes,!i streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-~IsPoSAI(SZ9 fS'~. 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 Comp!ianee from architect or engineer responsible forthe building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-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 an~ 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 Buildinm - $100.00 3. Copy of Certificate of Occupancy - ~ ,~510 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Dat~ .... ./~. 7.~f.~.~ ......................... New Construction ........... Old Or Prerexistinm B~ildinm ............... Location of Property.~ ......... ~.~..~. .... ~~. ~. ¥ //~ onWer or O~ers of Property~.d.~.e.~..~..~,~.. · ,ooo, ..... ......... ....... .......... .................................. Filed Map ............ Lot ...................... Subdivision .. No..Z/.~.~.~....Date Of Permit .............. .. Applicant ............................. Permit Health Dept. Approval ......................... .Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $. ............................. . .'4.. ..-: .............. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION []FRAMING [ - I~F~NAL ~,,./~//~,~. ] FIREPLACE & CHIMNEY REMARKS~ FIELD. INS.PECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY O,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD B~UILDING DEPARTMENT ~ -- TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180~ Approved P,=,; ,o.' APPLICATION FOR BUI LDING PERM IT Application.o.//.? .~. · ......... · Date/~./ ............ ,19 ~.Z_ 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 t~ schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premise~ 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 Bufldini Peri, it. d. Upon approval of this application, the Building Inspector will iasue a BufldinE Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No bui]dinE shall be occupied or used in whole or'in part for any purpose whatever until a Certificate of Occupancy shat have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildin~ Depa~h.ent for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Suuthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constroction of building; 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 ~egulatio~, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~.;..zt'.¢/.~4 .,Z....~...~.../~¢..... (Signature of applicant, or name, if a corporation) ........ //2. ~..~-...~..:..,~./~.. ..... ././~. ~..~ .... (M~il!~g address Of applicant) State whether applicant is owner, lessee, agent, architect, eng/neer, general contractor, electrician, plumber or builder. ................................... ~. ~...~.~..~,~... ......................................... Name of owner of premises ..... /~'~.~.~..,~./~....~...A,~//..C.~'...~'.Z/~...~..~°..~..~. .~..'. ....... ' .............. (as on the tax roll or latest deed) If applicant is a corporation, .signature of duly authorized officer. ~ (Name and tire of corporate ~cer) 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. ~../.'~.. ..... .~..~.,~. ~"... ~/./'..~.. ,~.-. ......... ·..~'....,'..-~.....~.. .......... ~'.e ~.. z~ ~.,..~....,e,~, ........... M..4. r~ z~..¢~ ,.. ~.,.~. House Number Street Hamlet County TaxMap No. 1000 Section .../CI.~ ........ Block .... ~. ............ Lot...~. .......... Subdivision ..... ~. ................................ Filed Map No ............... Lot ............... (Name) 2. State existing use and occupanCY of prem. ises and intended use and occupancy of proposed cons .t~oction: a. Existing use and occupancy .... .~'"~.~.~'.l~l~?..../C,~' .~.~.D~, .C'. '~'-~.. ,~.y....,,~/./~.~... 7.~.. ~,'~ ~ .... b. Intended use and occupancy ................. : .... ; C't/~'~: ~'~i ~ ........................... 3. Nature of work (check which applicable): New Building .......... / Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ ~//,e~ .---- (Description) 4. Estimated Cost .......... ~..DP.O,.O..O.... Fee ...~. ................................ (to be paid on ~ing 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 ..................... 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 ........... t .......... Number of Stories ............. Z ........ 8. Dimensions of entire new construction: Front .... -.3. (~ ........ Rear .~ ~ / ....... Depth . ~ ~ ........ Height .... .,/~../ ...... Number of Stories' .'. '. ~. ~../. 9. Size of lot: Front ...................... Rear ' Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated .......................... 6' ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ~. ........................... 13. Will lot be regraded ..... '.'x~..O. .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~r~.)/./..4_.~q4/.e.e. ~.e.~A .q4/Address .... /~..~.. ~ '. .... Phone No ................ Name of Architect ........................... Name of Contractor ./~rd~v~../.Z4-.~..~n..~..,ff.J.... .....Address Phone No. Address i i~.'~i~i iii i ilPhoneNo, i .~i)i .L'i~:~.' .~..~-- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. J STATE OF COUNTY O~kj.. ..... .'. ....... ~ ............ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) 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 application 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 filed therewith. Sworn to before me this ............ ..day N°t a~g,,Publ, ic ........ ~°e;m52[8~Ji2rS.~5?,.,~,~f~l, ik g~t¥~' (~i~gnature of applicant) ~J .(.,'"0 AP¥.O', £D AS NOTED NO~Y B111L~Ih!G DEP,;x-Rq'M£NT ~IGN OR CONSTRUCTION ERROR5