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Home My WebLink AboutZ-20459FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-20459 Date JANUARY 8~ 1992 THIS CERTIFIES that the building Location of Property 19105 MAIN ROAD House No. County Tax Map No. 1000 Section 108 ONE FAMILY DWELLING MATTITUCK ~ N.Y. Street Hamlet Block 4 Lot 5.2 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9~ 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-20459 dated JANUARY 8~ 1992 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 ONE FAMILY DWELLING WITH ACCESSORY TWO CAR WOOD FRAME GARAGE* The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF2ILTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Rev. 1/81 DONALD & DALE M. BERGEN ///Building Inspector Location Subdivision Name of Owner(s) Occupancy Admi'tte~ by: Key available Source of request 19105 MAIN RD. {number & ssreet) BUILDING DEPARTMENT TO~2N OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT MATTITUCK, N.Y. (pkmicipality Map No. Lot(s) DONALD & DALE M. BERGEN A- { RESIDENTIAL ktype) OWNER owner-- JOHN WILSON Accompaniod 'by: SAME Suffolk Co. Tax No,1000-108-4-5-2 DALE M. BERGEN Date DEC. 30, 1991 DWELLING: Type of construction Foundation CEMENT BLOCK Total rooms, let. F1 WOOD FRA~ 5 Cellar PARTIAL 2nd. F1 3 #stories 2 STORY Crawl space ~rd. Fi Bathroom(s) 2 FULL BATHS Porch, type. Deck, -ts~pe. Breezeway Garage. Type Heat OIL & ELECTRICWarm Air Fireplace(s). ONE Domestic hotwater Other Toilet room(s). Patio, Utility room Hotwater xx type No. Exi ts__ 2 Airconditioning Type heater OIL ACCESSORY STRUCTURES: Garage, type const. 2 CAll WOOD Swimming pool Other Storage, type const. Guest, type const. VIOLATIONS: Housing Code, Chapter 52 ..,Location Description I Ar~:[ Sec. Remarks: BP ;4262Z-CO Z-3602 Inspected by: Date of Insp. JAN. 6, 1992 Time start 9:30 end 9:50 TOWN OF SOUTIIOLD , 9,,j~ /~{ BUILDING DEPARTMENT TOWN tt 'C 3 0 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filied 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 ali buildings, property lines, streets, and unusual natural or topographie features. 2. Final Approval from Health Dept. of water supply and sewerage-disposai(S-9 form). 3.Approval of electrical instaliatlon from Board of F£re 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 Compliance from architect or engineer responsible for the building. 6.Submit Planning Board Approval of completed site plan requirements. ,,Fur existing. . buildings. (prior to April 9, 1957) non-conforming uses, or buildings and ~-'~2~x~g~l~Ladu~ses: ....... 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. 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. ~. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10~0 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .................................... Construction .......... Old Or Pre-existing Building.. .~...; ....... I.ocation of Property ....... 7.~ ~7 ........... J/~.~. ;g .~?~ ............. ~..,~j~-~ .~ ~ff ......... House No. Street Hamlet ~wer or Owners of Property .... ~~ ~ O~,f ~ ~ {~. .Joun~y Tax Map No 1000, Section .... ~.~ .... Block ........ ~ ...... Lot .... ~ ............ ................................. Filed Nap ............ Lot ..................... ~;ubd ivisioa ..... :>ermit No ................ Date Of Permit ................ Applicant ............................. fiealth Dept. Approval .............. Underwriters .... Approval 'lanning Board Approw~l ........................ ',equcst for: Temporary Certificate ........... Final Certicate ........... Submitted: $ ....................... ~- q '" · ................... ~ [-~L~{)q~q ' APPLICANT CONSE?~'T TO INS I~IE C'Fi ON Oxwner(s) Name(:D do(es) hereby state: the und(~rsigned, That the undersigned (is) (are) the(6Wnyr~) of tile premiser; in thc Term of Southold located at __/~ / o~f ~ ~t. ~ which is shown and dcsir~nated on the Suffolk County tax map as District 1000, Section That the undersigned (has) (bare) filed, or caused to be filed, an applica- tion in the Southcld Totem Buildin.~ Inspector's Office for the following: That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comp!y with all of the laws; ordinances, rules and regulations of the Town cf Southold. The undersigned, in consentin~ to such inspections, do(es) so x~ith the knowledge and understandin~ that any information obtained in the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regrulations o£ the Town of Southold. (signature) 0 (priut name) (siRnature) (print name) IT~C. Area: 8( W 26607 s.f. 103. 00' r ~or me~ bJ North Fork Z ~ 0 0 N.86°4`3'00'W. N'8`3°25'O(~'W. N. 87o42:,~0,,W 26757' - N. 86o F MAIN ROAD ( N.Y.S. RTE. 25) NOTE: I. · : MONUMENT A: STAKE 2. SUFFOLK COUNTY TAX MAP DIST. I000 SEC'~ 108 BLK 4 LOTS, 2 6 5'3 SURVEY FOR DALE BERGEN & DONALD BERGEN AT MATTITUCK DATE: DEC 5, 1991 1OWN OF $OUTHOLD SCALE: I"= 40' SUFFOLK COUNTY, NEW YORK NO. 91' lose #U#AUTH~IZED ALTERATION ORADDITIO# T~ THIS CERTIFIEDTO: SURVEY I · VI~ATI~ ~ SECTION 7~0~ OF TIdE SUFFOLK COUNTY NATIONAL BANK ~w YO4M( STATE [~&TIO# k. AW CHICAGO TLTI C~r r~UDANY YOUNG & YOUNG RIVERHEAD, NEW YORK ALDEN W, YOUNG, PROFESSIONAL ENGINEER ANO LAHD SURVEYOR N,Y.S, LICENSE NO. 1:~4S HOWARO W. YOUNG, L.ANOSURVEYOR N.Y.S. LICENSE N0.4S893