HomeMy WebLinkAbout44847-Z �o�agufFDl�CpG Town of Southold 7/27/2021
a y� P.O.Box 1179
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53095 Main Rd
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�y�yol �A�o Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42192 Date: 7/27/2021
THIS CERTIFIES that the building HOOD FIRE SUPPRESSION SYSTEM
Location of Property: 57225 Route 25, Southold
SCTM#: 473889 Sec/Block/Lot: 63.-3-21.5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/14/2020 pursuant to which Building Permit No. 44847 dated 6/9/2020
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:
ansel system as applied for.
The certificate is issued to 57225 Main Rd LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Authorized Signature
rr TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y x TOWN CLERK'S OFFICE
"o • SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 44847 Date: 6/9/2020
Permission is hereby granted to:
North Fork Rlty Assoc LLC
57225 Route 25
Southold, NY 11971
To: install an ansel system as applied for.
At premises located at:
57225 Route 25, Southold
SCTM # 473889
Sec/Block/Lot# 63.-3-21.5
Pursuant to application dated 5/14/2020 and approved by the Building Inspector.
To expire on 6/9/2021.
Fees:
COMMERCIAL ADDITION/ALTERATION $250.00
CO-COMMERCIAL $50.00
Total: $300.00
Buildi g Inspe
oe souTyolo
# # TOWN OF SOUTHOLD BUILDING DEPT.
Mum, 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING ] FINAL
[ ] FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
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DATE INSPECTOR
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631)765-1802 Planning Board approval
FAX: (631)765-9502 �� �� Survey
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 20 Single&Separate
Truss Identification Form
Storm-water Assessment Form
Z® Contact:
Approved 20 Mail to:
Disapproved We
Phone:
Expiration ,20
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date i ,20�
INSTRUCTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 waterways.
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 issue a Building Permit to the applicant.Such a permit
shall be kept on the premises available for inspection throughout die work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months.Thereafter,a new permit shall be required.
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 bbtistruction of buildings,additions,or alterations or for removal or demolition as herein described.The
dpplicant'agrees tocomply, ' th all applicable laws,ordinances,building code,housing de,and regulations,and to admit -
authorized inspectors on premises and in building for necessary inspections.
M AY 1 4 2020
ignature of applicant or name,if a corporation)
(Mailing address of appli nt)
State w ther ap licant is owner,lessee, gent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises C-5 4 /J Q; b- -�
(As on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer
(Naive and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on wluchroposed r will be done:
House Number StrEet Hamlet i V
County Tax Map No. 1000 Section VD Block 6 � Lot a l d
r
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intend d-use and occupancy of proposed construction:
a. Existing use and occupancy 19n devb__O�
b. Intended use and occupancy
3. Nature of work(check which applicable):New Building Addition Alteration _
Repair T Removal Demolition Other Work
(Description)
4. Estimated Cost 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
Depth Height Number of Stories
8. Dimensions of entire new constriction:Front Rear Depth
Height Number of Stories
9. Size of lot:Front Rear Depth
10.Date of Purchase Name of Former Owner
11.Zone or use district in which premises are situated
12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO
13.Will lot be re-graded?YES_NO Will excess fill be removed from premises?YES_NO
14.Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO
*IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?*YES NO
*IF YES,D.E.C.PERMITS MAY BE REQUIRED.
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
18.Are there any covenants and restrictions with respect to this property?*YES NO
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK) LOREM LMS
SS: NSI Nb11%ft to Of NOW Yuck
COUNTY OF, Al LM17M
iceU L being duly sworn,deposes and says th"OdIR Cowl y
Name A in(Widual signing contract)a ove named, Til M EVhW 09=111M We M. tj
(S)He is the Cy I to C
(Contractor,Agent,Corporate Officer,etc.) ,
.ti
of said owner or owners,and is duly authorized to perforin or have performed the said work and to make and file this application;
that all statements contained in this 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 tobefor a this
4�L— daV of &47atj 20
tart' ublic Signature of Applicant
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EQUIPMENT SURFACE NOZZLE SHELF BRACKET #100013 x Manual Pull is located a maximum 20 ft. from hood and 4 ft
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