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Home My WebLink About21912-zFORM NO. 4 TOWN OF 8OUTBOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCGuFANCY No Z-22973 Date APRIL 28, 1994 THIS CERTIFIES that the building ALTERATION Location of Propert~ 4050 CAMP MINEOLA RD. MATTITUCK, N.Y. 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 10, 1994 pursuant to which Building Permit NO. 21912-Z dated FE~UARY 23, 1994 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 ENCLOSE EXISTING DECEWITH SCREENING ATTA~U~D TO SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT BERGAMINI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A / ~uilding Inspector Rev. 1/81 FORM NO,3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. No 21912 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ...~,.r~...~ ..................................................... ,- . ' ............... : .......... F ............. 7'5 ................ L'":.: ......... F'" .~ to.....~.- .,(~....c=.. ~'(_2,,F. ~, ........ ~..~......':~-~-~,~,,~:,,~_ ,~ .~- .~-m',/,,,~ ........ ~ .........~,~-~.~'f....~- ........ ~_~ .~:~.~.,..~.~,~ ........ t~......~ ........ ~i;~..~.~ ......... ~'../.-..~...~......~-~::.~ ......... ~:.. ~.~ ....... ~..~ ........................ ,~... ................................ ~..... .......................... ...,, ..................... County Tax Mop No. 1000 Sectlon...../2.':~ .......... Blook,,...~"~ ........... LotNo ..... ~ ............... /Z~,~ /~ 19..~...~....'., and approved bythe pursuant fo application dated ........................ : ................................. , Building Inspector, Fee $... K',:: ................. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~N HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 i~ 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. 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 dwelli~g $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-existinR Buildin~ - $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 ~. ~...~/.'~ ~. ........... uocation of Property...t"~...'r'~..~t~.~..~.!..~.~.~. ......... ~ ...~ ............... House No. Street Onwer or O~ers of ~roperty.....6.~...~.~,.~ ................................ .. . . / ¢..8 "%~ .~...o. County Tax Map No 1000, Section ........... Block ................ Lot ................. Subdivis~n .................................... Filed Map ............ Lot ...................... .... ~,~,~,'~ ....... ,z,/~/~,¢ · licant ~'3~o..~,¢...~..~ ~erm~c ~o ................ uaue U~ ~erm~E..~....~ ........ ~pp ............... Health Dept Approval . ~-'. Underwriters Approval / .... Planning Board Approval ........................ Request for: Temporary Certificate.,~...-%~... .... Final Certicate...¥ ....... Fee Submitted: ~ ......... ~,~ ......... ~.: ...... ~.O. B~ ~ I~ItitUCk. NY 11952 ~ ~ ~ ~ ~.~ ............ ~,~,~i~ · .~/~~. ...... ~...~ ..... FOUZ;DATION (1st) FOU~_DATIOII ____~(on~ ) _ 2. ROUGH FRAME & · FLUNBING INSULATION PER N. STATE ENERGY CODE FI~;AL I · ADDITIO~L COMi-~E~;TS: BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ;ZND [ ] INSULATION [ ] FRAMING [ ] FINAL DA'~ INSPECTOR Construction UN~IERWRITERS CERTIFICATE REQUIRED FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B02 ., 19 f/~ermit No..~./~/,~.~.... Disapproved a/c ..................................... BOARD OF HEALTH ......... -3 SETS OF PLANS .......... __JSURVEY ................... _ fCIIEcK .................... SEPTIC FORH .............. - / . APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS 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 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 construction of buildings, 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 regulatio~ns, and to admit authorized inspectors on premises and in building for necessary inspections. /'1 ~- i ...... (Signature of appJ/~ant, or name, if a corporation) 4,. ..... (Mailing address of applicant) State whether applicant is owner..lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....~..' .~. ~..~..,&3~. 1..C_.._c).~..~ )~..~,.c.~..o..~.. ................................... APPROVED AS.NGTED ....... (as on the tax roll or lates~:ile~''t''v BY: ~3'. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~..~.~.,. ~..~.~.../T/Z- ........ Plunther's License No ......................... Electrician's License No ....... ~ ............ Other Trade's License No ....... .,.,,el. ............ NOTIR' BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED EOR PO[.JF{E ~ CO~JCRETE 4 F?,iAL COr~STRLICT~ON MUST F3~ COMPLETE FOR C,O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. N~ RESPONSIBLE FOR . DESIGN OB CONSTRUCTION ERRORS on which proposed work will be done ............. ~ ~ . .trzz~...,~.,./~., ~ .-~/.-~'.,:c?. !.r-:,t..~ .a~-~.... ........ Location of land .q. ooc..o .............. < ........... ........ ............ House Number Street Hamlet County Tax Map No. lO00 Section ..... /~..~. ...... Block ...d.'7 ............ Lot ..... .~, .C3'.' .......... 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 occupancy ......... .~..~.? ~ .............. b. Intended use and occupancy ........ .S..C.~. e..~. '.e.d.... x~...Dx~.~.. ........................... t 3. ~ work (check which applicable): New Building ........ ./~-dAdd'iti~n .~. ....... ~_Rep~r_~..~ ............ Removal .............. Demolition ~ .... . .~X5/,.. Other Wot& 4. Estimated Cost .... ~o ~a', 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 ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ................................ .~ .... ~.. ..... ,,. ;~,',' ..... Dimensions of same structure with alterations or additions: Front ..... ~.. Rear ~d.~. ~3~. '..~. ~ . . . Depth ...................... Height ............ .~ ......... Nunther of Stone~...-~.....~.~..., 8. Dimensions of entire new construction Front ..... e'~...~. ..... Rear .... g'.o~Q ....... Depth ..... ~.: ....... Height ...... ~ ...... Number of Stories ............. ~.~ ...................................... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of For:ruer Owner ............................. 11. Zone or use district in which premises are situated ............ ~(...~..*..~..-.~.~21 ........................ 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ............................ 13. Will lot be regraded ....... .-, ...... ~...d? .... x ...... Will excess fill be removed from premises: Yes /" No. 14. Name of O~ner of premises ~. ~..~/:R/.4'( .'.. Address (--2~tuj)t~,l.q;o./$[. Kq4. Phone NO. 'IIl1~.~ ......... Name of Architect .,,~'.O.q.~. ................ Address ................... Phone Nf'~--~,~ ~..2~.7...~.../.. Name of Contractor .......................... Address ................... PhonejXJo ................ 15. Is th±s property within 300 feet of a t±dal wetland? *Yes ........ *If yes, Southold Town Trustees Permit may be required. 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. STATE OF NEW "i~'RK.~f- //~-,, ,, '"" COUNTY OF....-::?f,:t...T'~..D./..~ a.a /,, --. .... ~{~, ~fl.~.~.. ~... ~.~) ~,-~.~ ~. (~. being duly sworn, deposes and says that he is the applicant (Name of individual mgmng contract) above named. He is the ............................ -::;.¢.~ .................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly afftho.~zed, t_9.1~efform or have performed the said work and to make and file this application: that all statements contained in ~his 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 .............. ~ ,.../~,...dayof.;.//.~...,.,.J~.~'....~..,1 ..~.' Notary Public,..~-_~._..~..~.~. ~LAIRE L GLEW" ''~' ' '~"~'~' '' County ...../d~.,~../ Notary Public, State of NeW Yo~k . .../~, ..:~?? ............ ~ ....... No. 48'/9505 ~[ / Qualified in Suffolk County r/~//~ / .= (Signatu~ ut' app~cm-,t) Commission Expires December 8, 19:2~.I