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Home My WebLink About16441-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17891 Date MARCH 27~ 1989 THIS CERTIFIES that the building Location of Property 5550 BERGEN AVENUE House No. County Tax Map No. 1000 Section 113 Subdivision ADDITION MATTITUCK ~ N.Y. Street Block 7 Lot 5 Filed Map No. Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this off~ce dated SEPTm~BER 8~ 1987 pursuant to which Building Permit No. 16441-Z dated SEPTEMBF~R 9~ 1987 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is · ssued is SECOND STORY ADDITION TO EXISTING ONE FAMILY DWF/,LING The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 LEO & MILLICENT RUSSELL N057808 - FEBRUARY 9r 1989 MARCH 21~ 1989-JW PLUMBING & HEATING / B~ulld~ng Inspector FOBM NO. · 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) NO_ 16441 z Permission is hereby granted~o: \ . . , .----, ,~ ~s ~.~...~...:..~....'...E...~. .................... ....................................... ~,...~.....~. .................. '-"~:.:-."2~'* "-"~'"'"~~-~ - -~-:' ..................... at premises located at ...~..~,Z~.'"~.....~-~.,A:~.....~.: ...... ...~....~ ................... County Tax Mop No 1000 Section ... /./...~.. Block ...... .l~...~ ....... Lot No ..... ..~..;~'... ..... pursuant ,o application dated .... ~.~:et:~e.....~ .......... 19.~.~., and approved by the Budding Inspector. Fee $.11~., .......... Rev. 6/30/80 TOWN OF SOUTBOLD BUILDING DEPARTHENT TOWN BALL SOUTHOLD, NEW YORK 765 - 1802 11971 BLDG. DEPT TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE '?~ NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........ HOUSE NO. STREET HAMLET County Tax Hap No. 1000 Section ./J.~.. Block ..-~. .... Lot .~- ...... Subdivision ....................... Filed Map ........ Lot .......... Health Dept. Approval..................~/S~//c * Underwriters Approval ~ Planning Board Approval Request for Temporary Certificate Final Certificate Fee Sub~i~ted: $ ............. 3 l?y rev. I0/ 14/88 J W PLUMBING & HEATING 909 BELLMORE AVE ISLIP TERRACE, NEW YORK 1].752 PHONE 277 4995 March 21, 1989 TO WHOM IT MAY CONCERN: This statement is to verify that the solder used on the home of Leo. Russell at 5550 Bergen Avenue, Mattituck, N.Y. was 95/5. JW Plumbing & Heating Suffolk wLic. #1773P TOWN OF SOUTiIOLD OFI'ICI~ OF BUILDING INSPECTOR P.O. BOX 117'9 TOWN IIALL SOU'I IIOLD, N.Y. 11971 MARCH 21, 1989 TEL. 765-1802 LEO & MILLICENT RUSSELL 5550 BERGEN AVENUE MATTITUCK, NEW YORK 11952 To Whom This May Concern, We are unable re complete your Certzflcate of Occupancy because of the fellowzng reasons. /~ An applicatzon ms not on file. (ENCLOSED) /_--/ No Underwr±ters Certificate on file. /~/ The check ~:, ~Y~LK~.~z~,~/not on file. ) /~/ Mo Health Dept. Approval on ~ilc. /~/ No final mnspectzon has been made. for Certificate of Occupancy $25.00 Please contact our office on this matter. Thank you for your cooperatzo~. iht [ld ~r,g Perln ~t ]! I 6 4 4 I Z Bu3- ld Lng Dept. *~*~ HO Plumber :3older Certificate on flle. ( all tmrmitu lnvolv%ng plumbing being zmsucd after April 1,1984 ) FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY CODE (2nd) FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [,~OtJNDATION 2ND [ FRAMING [ ] INSULATION ] FINAL REMARKS: DATE /// / ~~NSPECTOR'~/~/~ 765-~.802 BUILDING DEPT. INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION ;ZND [/--~NSULATION ] FRAMING ~] FINAL · .,>,"?. , ,,'?.~ / RE. lARKS. C~//,~.,. ~-_ ~ ,.>.~/-"/,~/'~ ~ DATE THE NEW YORK BOARD OF FIRE UNDERWRITERS t0~5010 BUREAU OF ELECTRICITY ~ 85 .JOHN STREET. NEW YORK, NEW YORK 10038 ~te ~'~;BRU~R¥ 09 · ~ ~ Application ~o. onflle ~4~0~/~ ~ 0~'~0~ THIS CE~IFIES THAT ~ ex. min~ on ~f~nd ~o be in ~mplian~ with the ~ui~ments of thb ~rd. RXTUIE OUTSJTS SWITCHES ]() IV ~ I%IRNACII MOTO~ RXTUR~S ~ OVENS EXHAUST FANS GERVICI mNL~T S E R V I C SHOR ],; Mr:c, ~2048 I,~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. be their credentials. COPY FOR BUll. DING DEP&RTkIENT. THIS COPY OF CERTIFICATE I/LIST HOT BE ALTERED IN ANY MAI4HER. Examined ~'9-,~ta4~ cI Approved%~..~'~o. .? Disapproved a/c .. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N Y 11971 TEL,. 765-1802 , 193-1 Permit No .) ~ql~/ ~ 3 SETS OF PLANS ...... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY ...... MAIL TO (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ......... 19 INSTRUCTIONS a Ttus application must be completely filled in by typewriter or m ink and submitted to the Budding Inspector, w~ sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showing location of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc st, or areas, and glvmg a detmled description of layout of property must be drawn on the diagram which is part of this a cation. ct The work covered by ttus apphcatlon may not be commenced before issuance of Budding Permit d. Upon approval of thru application, the Building Inspector wall issued a Bmldmg Permit to the applicant Such pe sl~all be kept on the premises avadable for inspection throughout the work e. No budding shall be occupied or used in whole ol in part for any purpose whatever untd a Certificate of Occup shall have been granted by the Building Inspector : APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Bmldmg Permit pursuant t, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmanc Regulations, for the constraction of buddings, additions or alterations, or for removal or demohtaon, as herein descr~ The applicant agrees to comply with all apphcable laws, ordinances, bmldmg code, housing code, and regulations, a~ admit antbomzed ~nspectorq on premises and m building for necessary inspections ~ .~. ./~.~/c-~ ~z~.~-~.-.~a7 ........... (S~gnature of apphcant, or name, ~f a corporation) (Madmg address of apphcant) State whether applicant is owner, lessee, agent, archztect, engineer, general contractor, electncmn, plumber or bm .. ......... Name of owner of premmes a(,e' o O ~ ?V~t:~'~.~-,,4:'~:~ Ac~ ~ 5~.~ '~ ~, .. (as on the tax roll or latest deed If applicant is a corporation, s~gnature of duly authorized officer (Name and tztle of corporate officer) ALL CONTRACTOR'S MUST BI~ SUFFOLK COUNTY LICENSED Builder's License No Plumber's License No Electmczan's L~cense 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 7 Hamlet · . Lot. ~ 2 Subd~vimon (Nm~e) Fded Map No . . Lot . State exmtmg use and occupancy of premmes and intended use and occupancy of proposed construction a Existing use and occupancy / ~>~,~, £~.'ez~,.,, c, b Intended use and occupancy . ,.?,. >-~,,?.... Z2.~.~-~.:.,c ...~, ...................... 3 Nature of work (check which applicable) New Building ...... Repmr . Removal .. Demolition Estimated Cost ~;~0~,~. ...... 4 5. If dwelhng, number of dwelhng units Addltmn . ..P~. .... Alteranon Other Work ~' (Descnpllon) ... ..... . Fee. . .. . .. . .. · · .... . . ..... ' (to be paid on filing th~s apphcation) ·. / .... Number of dwelhng 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 Dlmensmns of existing structures, ~f any Front . fi.,9 · Rear ....... Depth riff./. .... Height /~ ' Number of Stones ./ ...................... Dunensmns of same structure with alterations or add~tmns Front ~o ..... Rear . . Depth ~' Height ~,~ ~. ..... Number of Stones ~ ..... - 8. D~menslons of entire new constructmn. Front . .~ c Rear ... ? ......... Depth & ~ .... Hmght ...... Number of Stones . .~ ..... '. ~'~ '~ '. ..... Depth .d,L~,~ ~ ..... r'" 9 Size of lot Front .. ~.cr .... ~ Rear 10 Date of Purchase ~ ~ ~,"/Z~2~ . . Name of Former Owner 11 Zone or use d~stnct in which premises are situated. . &~'~ ~'~c~'- . ..... 44 12 Does proposed construction violate any zoning law, ordinance or regulation . 13. Will lot be regraded /, ~ ............ Wdl excess fill be removed ~' ~ '~e : [j~N~ 14. Name of Owner of premlses Z~:a .p..X{¥~/~ .Address 9/.~ ~'s'~o~E~... Name of Architect .... .4~-, .~0 A~.*~//.. · Address ....... %: . , . Name of Contractor .... ~-~.. (9....//5 ~ ~ c ~/ . Address ....... Phone No ....... 15. Is this property located wzthin 300 fee[ of a tidal wetland? *Yes ..... No .~%.. · If yes, Southold Town Trustees Permmt maybe required. PLOT D~AGRA~ Locate clearly and distinctly all braidings, whether existing or proposed, and indicate all set-back dunenslons frm~ property hnes Give street and block number or descnpnon according to deed, and show street names and mdmate whethe interior or corner lot. ~ STATE OF NEB' YORK, COUNTY OF SS (Name of m&wdual signing contract) above named being duly sworn, deposes and says that he ~s the apphcar Sworn to before me this ......... ?-.. day of Notary Pubhc .... ~ ~'. He ~s the · · (Contractor, agent, corporate officer, etc ) of smd owner or owners, and is duly authorized to perform or have performed the smd work and to make and file th apphcat~on, that all statements contained m this apphcatmn are true to the best ofhts knowledge and belief, and that th work wflI be performed in the manner set forth m the apphcatlon filed therewith ..... ........ County ~.t~ ~ (St~ature of apphc~ 4~ ~k ~ ? USE IS UNLAWFUL C~'//'/=~'E o/' occ,.,,~,vc~ .....¢_.- ---- ,. WITHOUT,,. CCU CERTIFICATE r~ 0 ~... P^NCY ~o~,~ ~,~E~, ~ ,'.~'E,, ' SUPPLY SYSTEM CANNOI' EXCEED 2/10 of I~ I. EAD. · ~ /¢ Main Road- '