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Home My WebLink AboutZ-25093FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF O~CUPANCY No Z-25093 Date JUNE 20, 1997 THIS CERTIFIES that the building Location of Property 19105 MAIN ROAD House No. County Tax Map No. 1000 Section 108 Subdivision ONE FAMILY DWELLING MATTITUCK, N.Y. Street Block 4 Filed Map No. Hamlet Lot 5.2 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-25093 dated JUNE 20, 1997 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 GARAGE * The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. BRUCE & LEIGH ANN BERGEN N/A N/A Rev. 1/81 BUILDING DEPARTHENT TOWN OF SOUTHOLD UOUSING CODE INSPECTION REPORT LOCATION: 19105 )lAIN RD. MATTITUCK, N.Y. (number & street) (municipality) SUBHIVISION MAP NO. LOT(s) NAHE OF OI~qER (s) BRUCE & LEIGB ANN BERGEN OCCUPANCY ADHITTED BY: KEY AVAILABLE (type~ LEE BERGEN SOURCE OF REQUEST: (owner-tenant) ACCOI4PANIED BY: SAI~ SUFF.CO. TAX MAP NO. 1000-108-4-5.2 BRUCE BERGEN DATE: JUNE 13, 1997 DWELLING: TYPE OF CONSTRUCTION WOOD FRAI4E FOUNDATION BLOCK CELLAR TOTAl, ROOHS: IST FLR. 5 2ND FLR. 4 BATUROOM (s) 2 TOILET ROOM (s) PORCH TYPE COVERED FRONT ENTRY BREEZEWAY FIREPLACE I)OHESTIC HOTWATER OIL TYPE HEATER TYPE HEAT STEAH (RADIATORS~APdvl AIR OTHER: ff STORIES FULL 2/3 CRAWh SPACE 3RI) FLR. UTILITY ROOM ~ECK, TYPE PATIO YES GARAGE OIL 2 ~ EXITS 2 I/3 AIRCONDITIONING 2 WALL HOUMTED HOT}/ATER UNITS. ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST. WOOD FICAME SWIPIHING POOl, OTHER: STORAGE, TYPE CONST. · GUEST, TYPE CONST. VIOLATIONS: CHAPTER 45 N.Y. STATE. UNIFOR{4 FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. REMARKS: INSPECTED BY BP #4262Z-COZ-B602 fAddi-tinn) DATE OF INSPECTION JUNE 17, 1997 TIME START I0:10 END 10:55 Form No. 6 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 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. 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. 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 !. 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-existinz Buildin~ - $i00.00 3. Copy of Certificate of Occupancy - .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate cf Occupancy - Residential $15.00, Commercial $I5.00 June t 1997 Date ......................................... New Construction ........... Old Or Pre-existing Building.~ ........... Location of Property..~ P~.q~ . ~.~q. ~P.~ ~ .~%~ ~ ~ ................................... House No. Street Hamlet Onwer or Owners of Property..P~.~'..P~q~..~.A~%g~.~..~¢.~.y~A(~ ........ County Tax Map No 1000, Section.~P~.'.9? ..... .Block ..... 04:00 .Lot..gPP.'.~9~ ............ none Subdivision .................................... Filed Map... none none · none N/A Permit No .... ~U? ....... Date Of Permit ................ Applicant ............................. Health Dept. Approval. none .Underwriters Approval. none Planning Board Approval ..... none Request for: Temporary Certificate ........... Final Certicate.~ .... Fee Submitted: $. ~.O.Q, .0.0 ..................... ~7 ~'~£'~ ~ ~ ~ C~ ~ BRUCE p. BE~E~ IN,~I I (.i I BRUCE D. BERGEN and LEIGH ANN BERGEN,his wife the undersigned, ( }(2.'~) hereby state: TI)at the undersj~D~ecl ~(at'e) [he owner(s) (~[' tim i)remises Ln [he Tow]) of ~ot)lhold located at 19105 ~a&n Road, MaaS&tuck, ................................. , which [~ Hh()wn and designated on 01(.. (J~)llllfy lax ilial) ~lfi l)JsIt'Jc.t ]01)0, ~](:tiOll ~08.00 Bhmk 04.00 l,ot 005.002 '1 h ~l Ihe undersi/~ned (has) (have) filed, or (mused Io I)e filed, au lk),) in lhe Southold '1 )w, Btlihliu~ Inspect,)r)s ()l'fice fop the f()llowi)u~: P~.C/9 PK.C.P~&~f!~e_2f _Zgn&~9 Compliance or Certificate of built pr~or to the enactment of zoning ordinances ~n 1957 That Iht undet, si~Ule(I (h)((~s) I~erelLy give ('.()us(mt Lo Hm Iht[l(linl~ any and all buildinf~s localed thereon, t(~ conduct such [nspet:l[ons as Ihey dt:~eni necessary with respect t() the afcnyesaid apl>lication, including inspeeli(ms 1¢> dt~t(~rmiue that said premises comply wilh all of the laws, ordinances, arm ]'eRuh~tions of the I'o~% ~d' Southohl. The undersigned, in eonseutinR to such inspections, do(es) 8o with Ihe kn()wh~df~e and understandhu~ Ihat any infer'marion obtained In the conducl of ~;LICH i~,spec:tions )nay I)e used ns evidence in subsequent pt'osecutions for J:tliott:: ()f the laws, ()rdinanees, rules (n' regn'latlo s of the Toxvn of S~)ullml(I. BRUCE D. BERGEN .......... ) .............. ,LE I~G_H~A.N__N_ B__E RG E_N. ................ (print name)