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Home My WebLink About22610-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23689 Date JUNE 6, 1995 THIS CERTIFIES that the building ADDITION Location of Propert~ 4050 C~MP MINEOLA ROAD MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 123 Block 5 Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 16, 1995 ~ursuant to which Building Permit No. 22610-Z dated MARCH 3, 1995 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 A DECK ADDITION TO AR EXISTING DECE OF A SEASONAL ONE The certificate is issued to FAMILY DWELLING AS APPLIED FOR. ROBERT J. BERGAMINI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A lding Inspector Rev. 1/81 FORM NO,3 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HAl& SOUTHOLD, N.Y. N~ 22610 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ~ / .,-, ~ , ...P..,..o..~.~.......m..~..~ ................................ .~...z.Z........c~ ....... .,.~...%.., ........ /z ...... ,o.....~~..~.~~...~~.~...~:~ ....... /~.~..~.*.~.~ .... ~.c./..<i .~.....,~.......~z~.~../.. ............... ............ ~.~¥~ .......... ~.. ~,,~...../,..~~.~ ..................................... CountyTaxMapNo. 1000 Section ........................./¢~'---~ Block .......................... '--('""-- LotNo. ............................ ~-i~ 19....~...,~ ...... and approved by the pursuant to application dated .............. ~.'~,.,,.~.....~,,.~., ............... ~ Building Inspector. Fee~..~ ........... Rev. 6/30/80 [ r [ ¢~ ~', ~l/~ [~ '!I~ Form NO. 6 [ Ii; '~ ~l~l OU~ [[~':[ BUILDING I)EPARTHENT [ ........................ ~ [ 765-1802 ........................................ *~PPLiCATION FOR CERTIPICATE OF OCCUPANCY A. TI~s aPPlication must be filled in by typewriter OR ink and submitted to the building inspector wi~h tb~ follOWing: for new building or new nsc: 1. Final survey of property with accurate location of ail buildings, property lines, streets~ and unusual natural or topographic features. 2. Final Approval from Hehlth Dept. of water supply and sewerage-disposal(S-9 form). 3. Apprnval of electrical installation from Board of Pire Underwriters. 4.' Sworn statement from/plumber certifying that the solder used in system couta~l-S less than 2/10 of 1g lead. 5. COaereial building, industrial building~ multiple residences a · ' · · and installations,~'a certificate of Code Co~-l¢ ..... ~ . , nd similar buildings 6. responsible for th~ building ,,,v**~-uu ~tom arcnxtect or engineer t Submit Planning Board Approval of completed site plan requirements. [. For existing buildings (prior to April 9 1957) non-conforming uses~ or buildings and ~pre-exzstxng land uses: '~ 1. Accurate survey of property showing ali property lines, streets, building and unusual natural or topographic features. 2. A properly completed application aud a consent to inspect, signed by d~e applicant. I~ a Certificate of Occupancy is denied, the Building [nspbctor 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 duelling $25.00, Svi,aing pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Buildina - $100.00 3.Copy of Certificate of Occupaucy - $20.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00., Co~ercial $15.OO' . ' tlouse No, Street County Tax M:p ~o I000, Section. · ..... ~lnck ............ Lot .... . ............ Subd~v~sLon .... ~ ' ................................ Permit No. · ..... Date Of Permit ..~ .... Applicunc~jffp~ [tealth Dept. Approval,.. ~ . ................ Underwriters Approval ..... ~i ............. 'lanning Board A~provai ........ iequest for: Temporary Certificate ........... Final Certicate ........ ret Subaitted: $ ....... I! INSULATION PER N.Y. Il II STAT]~ EJ~J]~J~G-~ J! II CODE ~D~T[ONAL CO~S: 't '! · (lla,,xI .p inod :::::) <~ <I: 0 12)'~J C) ' d ,,Ob' , ~,~ 08 5'! Uall~/ '~ 'O r- B~ 765-1802 UILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [~~L [ ] FIREPLACE & CHIMNEY REMARKS: ~/~~ ~ ~/~/// FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 19S.~. f 6¢o.' 19 . .~. ~ermit ........... Disapproved a/c .' ........ /EICATION FOR BUILDING PERMIT BOARD OF HEALTH 3 SETS OF PLANS SURVEY CI1ECK ............ CALL . . . HAIL TO: INSTRUCTIONS a. Tl~s application must be completely filled in by typewriter or {n ink and submitted to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationkhip 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. o. 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 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 applicable Laws, Ordinances or Regulations, for the const~efion of buildings, additions or alterations, or for removal or demolition, as herein described. The a~p~ican:t' agrees to comply w[~t.h all applicable laws, ordinances, building code, housing code, and regulations, and to admit autho, riged~insp~ctors on premises and in building for necessary inspe~ions. ~ ~ ~/~ (Mailing address of applicant) / State whether applicant is owner,.lessee, agent architect, engineert,,g~qg~ntractor electrician, plumber or builder. N~e of owner of premises . ..~. ~. ? ....... ~Q.. .~.t~.~a.~ ........................ , ..... (as on the tax roll or iates[ d~e/i}- If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's Liccnse ....... Plumber's'License No ............ y ......... Electrician's License No ...... ~ ............ Other Tr~de's License No. / .................. Location of land'on which proposed work will be done .................................................. House Number Street Hamlet S County Tax Map No. 1000 Section Block Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occuuancv ~ m ~ {~ _ ' ~ _~ x ~, ~ -- , ~o e~ ~ V~A1BM ............. b. Intended use and occup nc ~ ~.[0~ ~ ~-~ ,~$ O~ ~ y ............. .~ ....... . ......'~~, ......... ~.... . property lines. Give street and blocklnumber . interior or corner lot. 3. Nature of work (check which iapplicable): New Building Addition.. Alteration ......... Repair .............. Removal .............. Demolition ........... :.. Other Work ............... - ~ ' '~ (D ripti ) 4. Estimated Cost ......... ' e oR ..... '- · .~ Fee .. . ...... i (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ < ....... Number of dwelling units on each floor ................ · If garage, num her of cars .... i ........... .~---~-~-...~']-.. ......... I..fb ............. ~ '~L;, 2"' '5->~' · '''' '' · '' .' 6. umness, commercJal or m~ ed occupancy specify nature and extent of * ..... ..... rxt . ..... ........... i ..... 7. ~lmenmons et existing structures, if any: Front ear .... ; ......... Depth ..... Height ........ umber of Stories .. ¢,~ .... '. 1 9~...?.. Dimensions of same structure vlth alterations or additions: Front ..... ~!+. P:5...~r..-... Rear .................. Depth ~ Height ..................... Number of Sro 'ies 8 Dhnension ....................... , ' Dipt~l · s of entire new cons/cruction: Front ./.O. ~' Rear ~ ................ Height ~..~ .r~. Number of Stories ........................ 9 Size ofl~t: Front ........ ' ........................ ;': ............................. · · ......... ~ ............ Rear.. 10 Date of Purchase .................... Depth ...................... ' ' Name of Fenner Owner 11 Zone or use district in which premises situated ........... ' .................... · are ............. ¢~-~ .. 12. Does proposed construction viqlate any zoning law, ordinmice or regulation: ........................ 13. Will lot be regraded ........ i .................... Will excess fill be removed from premises: ~. Yes 14. Name of Owner of premises ,-5~¢../'?..~ .... ,¢..$ ...... Address ...O'-/Ye¢..~. gq: 5, . Phone No. ~.7..~.~.8~. Name of Architect .. ....... ................... Address ................... ; Phon~ N%m No ........... 15. 3'f C°ntract° ~..~..1~....~..~.. ~.. Address ./~..t.'t~.r/.e.4. e-.~....~./Phon6 No.,~2¢~..".~t. 7.E..~ t. uzs property winnin 1300 feet of a tidal wetland? *v~=''' ~>'*'';,;~ '' · If yes, Southold iTown Trustees Permit may be required. ' .... .... , PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or prolSosed, and, indicate all' set-back dimensions from or description according to deed, and show street names and indicate whether { UND£RWRffER$ C£RTfflCAT£ '~ A~PllOI/E?..A~ I~OTED FEE[~'.~ ~R¥. [, r._~,,~ ~,~ N]6?v ~uILD~NG FOLLOWING INSPECTIONS: 'L FOUNDATION . TWO'REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O. ALL CONSTRUCTION SHALL MEET THE REOUIREMENT~ OF THE STATE CONSTRUCTION & ENERGY COBES. NOT RESPONSIBLE FOR DESIGN OB CONSTRUCTION ERRORS STATE OF NEW YORK, COUNTY OF ......... S.!S · ' ' ' .............. ..~.. being duly sworn, deposes and says that he is the applicant (Name of individ mil' signing contract) above named. ' (C ffi ) ......................... . ontractor, agent, corporate o cer, etc ' ' >f said owner or owners, ~d is duly ' ' authorized to perfom or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ner s~t forth ~ the application filed therewith. Cwom to before me this .......... a ..... ...... ' ,'craw Public,. ~~~~'~. ' ' N~ARY ~. ~e ~ N.~ ......... . -. Term REEVES AVENUE~ ,~L$O KNO~IN AS cAMP MINEOLA ROAD polricia Murphy 30.0 $. 4 °4~ 'O0"E. 105.45'1 % % N 4°49 O0 W. 126. Ke I/y