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Home My WebLink AboutZ-27990FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUP~/~CY No: Z- 27990 Date: 10/03/01 THIS CERTIFIES that the building DWELLING Location of Property 1185 MILL RD (HOUSE NO.) County Tax Map No. 473889 Section 106 MATTITUCK subdivision (STREET) (HAMLET) Block 0009 Lot 008.004 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 ~3MB~ Z 27990 dated OCTOBER 3, 2001 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 ENCLOSED PORCH.* The certificate is issued to RALPH & HELEN BERGEN, JR (OWNER) of the aforesaid building. ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTNOLD WOUSING CODE INSPECTION REPORT I~TIO~: 1185 MILL RD MATTITUCK SUBDIVISION: ~ OF OWNER (S): RALPH & HELEN BERGEN~ JR OCCOPANCY: A 1 RESIDENTIAL AI~4ITTED BY: HELEN MARIE BERGEN NO.: ~ (S) RALPN & HELEN BERGEN~ JR DWELLING: ~fPE OF CONSTRUCTION: WOOD FP. AME FOUNDATION: BRICK~ CONCRETE BLOCK & STONE VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. BATHROOM WALLS AND FLOOR ESPECIALLY TUB AREA STRUCTUR3tL MEMBERS SHALL BE PROTECTED WND MAINTAINED TO RESIST /tND PREVENT DETERIORATION WALLS SHALL BE MAINTAINED IN SOWND CONDITION BATHROOM FLOORS SHALL BE MAINTAINED IN WATER- TIGNT CONDITION PART PART VOL9B 1242.7 1~: BP#l1980 GAP~AGE C0~Z27989 DATE ON INSPI~CTION: 10/01/01 TI~ START: 10:05AM ~D: 10:45AM Form No. 6 TOWN OF SOUTIIOLD !: ~ ~ ,' BUILDINGDEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 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. B. 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 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-existinR Buildin~ - $i00.00 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 Auqust 2 .2.00.! Date ............. ~ ....................... New Construction ........... Old Or Pre-existing Building .... .X ............ Location of Property .............................. Mattituck 1.185 . Mil.1 R. oad ....................................... House No. Street Hamlet Onwer or Owners of Property Ralph Carl Bergen, Jr. and Helen Marie Bergen County Tax Map No 1000, Section...1.0.6. ..... Bi ck 9 .8 4. · . . o ................ Lot ..... · ............... Subdivision ............................. Filed Map ............ Lot ...................... Permit No ........... Date Of Permit ............. Applicant ............................. Health Dept. Approval ....................... Underwriters Approval ......................... Planning Board Approval .................... Request for: Temporary Certificate ........... Final Certicate .... ~ ...... Fee Submitted: $ 190-0.0. . . . J ...... Helen Marie Bergen /¢