The URL can be used to link to this page

Home My WebLink About12698-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 8outhold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z19286 Date AUGUST 13, 1990 THIS CERTIFIES that the building. PROFESSIONAL OFFICE BUILDING Location of Property. 32495 MAIN ROAD CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 097 Block 05 Lot 4.4 MINOR Subdivision JOHN MIESNER Filed Map No. 303 Lot No. 2 conforms substantially to the Application for Building Permit heretofore SEPT. 30, 1983 filed in this office dated MAY 30~ 1986 pursuant to which 12698Z OCTOBER 21, 1983 Building Permit No. 14933Z dated JUNE 3, 1986 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 NEW PROFESSIONAL OFFICE BUILDING - FIRST FLOOR ONLY The certificate is issued to ANNE H. OLSEN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N646395 - N753927 PLUMBERS CERTIFICATION DATED N/A UPDATES C.0.Z16248 and COZ16249 OCT. 5, 1987 FINAL PLANNING BOARD LETTER 4/19/90 C26 - MAY 31~ 1984 -- ~uilding Inspector ' ' FO]~ NO. 2 TOWH OF $OUTHOLD BUILDING DEPARTMENT TOWH HALL $OUTHOLD, bL Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 12698 Z Permission is hereby granted to: ...... ~J~.....~...~....~...~ .................... ...... ./~.~..~.~.~.~... ~Z...~. ~. .................. ..... ~m~..~.~...,..~..,..~ ........ ~. .... to ....... ~.~.. ............... ~ at premises located at .....~../~..Y.~.~T~L..~....t~,d~2/~......~-,~,~..~,.....>,~.~.~..~..~-~..U..~.~.~/..~x~' County Tax Map No. 1000 Section ...~...C~,,.,~,,, ...... Block .,~,..~,,~,, ....... Lot No.' ,,~, ,~, ~ ~urs-ant to app,cat~on ~ated ..... ..~.~-~.~.7:.......~. ....................... , ~, an~ appro~ ~ the Building Inspector. Fee ,..~..0......~ .. :.;....7..~ B~llding Inspector Rev, 6/30/80 Form No. 6 TOWN OZ SOUTHOLD BUILDidG EEPARTMENT 765-18CZ 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 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 '3pre-existing" land uses: i. Accurate survey of property showing ali 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. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 I~PDATE C O Z16248 Date AUGUST ]O,. 1990 Z 16249 New Construction ........... 01d Or Pre-existing Building 32495 MAIN ROAD CUTCHOGUE Location of Property .................................................... . . .~ ................. . House No. Street Hamlet Onwer or Owners of Pro-ert,, ANNE H. OLSEN ty 1000 097 B1 k 05 4 4 Coun Tax Map No , Section .............. oc ............... Lot... ' Subdivision ............................... .. .. . Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ................... ... .. . Planning Board Approval ........................ Request for: Fee Submitted: Temporary Certificate ........... Final Certicate ........... 50.00 FOR UPDATED C.O. l/ /qc ................................................ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property w[th accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-la-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3, Copy of certif[cate of occupancy $ 5.'00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date . .F.e.b?.u.ar~..4;. 3.9.8.7 ......... NewC°nstpuc%ion Old or Pre-existing Building Vacant Land Location of Property .3.2.4,95 .M.a.~n Road, 'Cutchogue, .New .Yor.k 11935 House No. Street HamJet Owner or Owners of Property . . .. .Ap.ri.e, .H.. ............................................... 01eeo. County Tax Map No. 1000 Section . . .0.9.7 ..... Block 05 Lot 004.004 Subdivision ................................. Filed Map No ........... Lot No ............. Permit No...1~.6~-... Date of Permit .1.0/.2/,8.3...Applicant..A?.n?..H....0.].s.e.n..b.y._.G.a.r.y..F.];a.r?.e.r..0.l sen Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate .............. inal Certificate .... X. ................. Fee Submitted $..5.0...qq ............. Construction on above described building and pE Rev. 10-10-78 Ap[ 33 9&3 ~{icable codes and regulations. ~N['R OLSEN, ESQ.. F.O. ~"' CUTO, HOGUE, L.I., N.Y. 11935 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~Jouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-{S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, s~'reets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $§.00 / .2. Certificate of occupancy on pre-existing dwelling/ land use --~'re-E×J.s f,±ng C.O. $15 · O0 ~3. Copy of certificate of occupancy $1,00 'v'acan't, land C.O. $ 5.00 Date March 27, 1986 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .e.a.s.%..o.f.f.i.c.e.s.,..f.i.r.s.%..f.l.o.o.r..o.~.I.y..o.f..n.e.w..o.f.f.:[.c.e..b.u.i.l.d.J.n.g.,..M.a.i.n..R.o.a.d.: House No, Street Cutchogue, NY Ham/et Owner or Owners of Property ANNE H. OLSEN County Tax Map No lO00Section ,0,9,7 Block ,0,5, Lot 004.4 S.i.vj,i~l°r' 7ohp ~.i.e, sp,e,r. ............... ~'~xl~;~ No ........... Lot No..2. ........... uualwmon ....... 303 it 1,2.6,9,8 .Z Dat of Pe mit .].0/.21/.8.3 Appli ANNE H. OLSEN Perm No ...... e r . ,, cant .................................. Health Dept. Approval .C. 2.6...5/.3,1/.84 ., .Labor Dept. Approval ........................ Rob~c. A. VilI'a', P'.~'.- Underwriters Approval ~1 .6.4.6.3.9.5 ~ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate . .'...X.X ................. Fee Submitted $ 5..D0 Construction on above descr'bed bu Id'ng and permit meets all applicable codes and regulations. Applicant .. ANNE H./0'~,P.0. Box 706, Cutch0eue, NY ..i]935 ;' -2' .......... : ............ FORM NO, 6 TOWN OF $OUTHOLD Buildin~ Dapartntent Town Hall ~;outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter. OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or now use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation frof~ Board of Fire Underwriters. 4. Comrnercial buildings, Industrial buildings, Multiple Residences and similar buildings end installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings {prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2, Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Data of any housing code or safety inspection of buildings or premises, or other pertinent lnforma- tiaa required to prepare a certificate. Fees: 1. Certificate of occupancy ' $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land C,O. $ 5.00 New Building ........ Old or P~re-existing Building r~ ........... Vacant Land/ ............. Location of Property'S. ·~. .~..~. ~ .~...~.~..~.~.~V~ ..~ ~.~.~.~ ,. ~ .............. Owner or Owner= of ProperW .... v.. '.~ ..... ~, .~ County Tax Map No. 1000Sect,on ..~ ...... Block: ...... ~ ..... Lot. , .... Subdivision ...... ~ .... /~¢.~ .... ~ No. ~.~,..Lot No .... ~ ...... Permit No. (..~..~..~.~. Date of Permit .......... Applicant ................................. Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate .'...(~. ............. ~qal Certificate ...................... Fee Submitted $ .~'~.~.~. ............ .~. ...... ~ //) '~'~' TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. TEMPORARY Certificate Of Occupancy No, Z125.2.7-.Temp~/ Date June 8 1¢84' THIS CERTIFIES that the building--east., of. fig.e~ t f.irst, flo. or .o.n,l¥ o.f new ~ .................... 6~fcg ~'uildi'~. ty ~{.a J,~ Bp.a.d ....... C..u ~.c.h.o. 9 .u.e' Location of Proper House/Po. Street Ham/et County Tax Map No. 1000 Section .... 09.7 ..... Block .... 0..5 ......... Lot . 004..4 Minor Subdivision.. John Miesner F41~4~ap No. 3. Q$ . .Lot No. 2 conforms substantially to the Application for Building Permit heretofore Fried in this office dated .$,~p.~.~..mlgg.r' 30 , 19 .83. pursuant to which Building Permit No. 12698 Z dated .... 9.c.~o..bg.r..2..1 ............ t9 .8..3., 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 ......... . eb.e.., eo~.~..9~,~.~.g*.~.,., f..~.r.s.e...f.~.o, qr.. 9n~.7:..o.f...n.? .p..rp.fp?..~.~.o. qa..~' .of: f..~.c.e...b.uildin, The certificate is issued to ANNE Ho OLSEN (owner,~,e~ o,f the aforesaid building. Suffolk County Department of Health Approval ..C...2.6.,..........~..5/3~/84' R.o.B.t.....A.:...V~.~la.,.... ....?'E' 646395 UNDERWRITERS CERTIFICATE NO .......... N. ....................................... Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUlL. DING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No.. Z-16248 Date October 5,. 1987 Z~-16249 CONSTRUCT PR.OFE. SSION.A.L OFFICE BUILDINGS THIS CERTIFIES that the building ............................................ Location of Property 32495 Main Road Cutchogue, New York House No. Street Nam/et County Tax Map No. 1000 Section 0 9 7 .Block 05 ...... Lot 4 . 4 MINOR Subdivision .~./.o..,.~ .o.h? ~ .e.s.n.e..r Fil d Map N ).0.3. L .......... e o ..... et No..2 conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept. 30, 1983 12698 Z May 30, 1986 14933 g pursuant to which Building Permit No ...................... October ~61983 June 3, dated .............................. was issued, and conforms to all of the requirements of the applicable provisions of the law. Tile occupancy for which tiffs certificate is issued is ......... NEW PROFESSIONAL OFFICE BUILDING - FIRST FLOOR ONLY The certificate is issued to ANNE H. OLSEN {owner, 7e~tto.Yo~ Y_d~;~X X of the aforesaid building. Suffolk County Department of Health Approval ....C.2.6.. 7..~ a..y..3. 1.:. 1 9 8 4 UNDERWRITERS CERTIFICATE NO. N 64 6 3 9 5 - N 75 3 92 7 PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev, 1/81 SUBJECT TO ONE YEAR REVIEW/ BY PLANNING BOARD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 MEMORANDUM: PLANNING BOARD OFFICE TOWN OF SOUTHOLD SCOq~F L. HARRIS Supervisor Fax (516) 765-1823 Telephone (516) 765-1: TO: FROM: DATE: SUBJECT: Victor Lessard, Principal Building Inspector Bennett Orlowski, Jr., Chairma~ ~.~/i/~.\ April 18, 1990 Construct Professional Office Buildings SCTM~ 1000-97-5-4.4 An inspection of the above referenced property was made on April 17, 1990 in conformance with the Certificate of Occupancy condition that a one year review be made by the Planning Board. The Board finds that all conditions of the site plan have been accomplished. B.P. 12698Z Z16248 B.P. 14933z Z16249 OOOT'a THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY Jt~le ~L:~ [~ 85 JOHN STREET, NEW YORK, NEW YORK ~pO3e THIS CERTIFIES THAT only the electrical equipment as described belo~ and i~troduced by the applicant ~m~ on the above application number in the premises of in the following Iocationio .[~l~asett%¢~t~ ~] 1st FI. was examinedon l~ ~ J.~C~ FIXTURE OUTLETS 57 ~ECEPTACLES SWITCHES [] 2nd FI. Outside Section Block and~ound to be in compliance with the requirements of this Board. Lot FIXTURES OVENS FANS NCANDESCENT FLUORESCENT ~4 .17 57 DRYERS SYSTEMS NO. OF FEET E E R OF CC COND. A W. O, pE~R ,~ OF CC. COND. APPARATUS: Pauelboards; l~gcir. 125~s~ ].~..12cir, 200~s~ 1--~.0~, Inst~t Hot Water 'Unit. 1-15. Okw~ Ileat V I C NO OF HI-LEG OF HI-LEG 21350 MC,I Ruland Electric P. O, tDx 14~ Mattituck, N.Y. 11952 Ltc. 242 'his certificate must not be altered in any manner; return to the office of the Board if incorrect. ~IG DEPARTMENT, ~HIS COPY OF C may be identified by their ' MANNER. 765-1802 BUILDING DEPT, INSPECTION FOUNDATION XST ~t~] ROUGH PLBG. ['1 FOUNDATION 2ND[] INSULATION i~,,~/] FRAMING [ ]FINAL /\ REMARKS: ~ FIELD.INSpeCTION COMMENTS FOUNDATION (ls%) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION FERN. STATE ENERGY 2.0DE FINAL A~DI~ tONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .., 19...g Disapproved a/c ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ~. ~..~. ....... Date ....S.e.p.t:..3.0.,.1.9..8.3., 19... 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 th~ igsuance' 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 regulations, and to admit authorized inspectors on premises mid in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. OWEtO~' Name of owner of premises Anne H. else n (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................... ~, .... Plumber s License No .... ~.~ ........... Electrician's License No. (r. ...... ( ........ ~... Other Trade's License No ...................... N. Side Main Road, Cutchogue, N.Y. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No, 1000 Section 9 ? Block 5 Lot p [o 4. Subdivision Minor Subdivision John Miesner Filed Map No. Lot 2 (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy BusiBess b. Intended use and occupancy office building h appli ) x 3. Nature, of work (check whic cable New Building .......... Addition .......... Alteration .......... Repair Removal' Demolition Other Work ~ : (to be paid on ~ing this application) 5 If dwelling number of dwellingUnits'" Numbe f dwelling' nits' on each floor If garage number of cars ' 6. If business, comr~r.~al or mixe0 o9cupancy, spece'ff~ nature and extent of eoac~h~ type of use .b.u.s.i.n.e.s.~,~qf.f;[9.e ~ ..... 7. Dimensions of e~i~ structure~, if any: Front. ¥ ?. ........... Rear . ?? ......... Depth. p.u. Height ...... 2 0 ! Num. be~ of Stories 2 Dimensions of same structure w!th ~lterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height .............. Number of Stories ........................................................ 9 Size of lot: Front i ~ Rear Depth 10. Date of Purchase .O. ctoberl i1983 %m_~ofFormer Owner .Jol~rl. Mqi. ar~er. qr use n w i,s ....................................... 11. Zone district i hich prom es are situated ...~ .......... 12. Does proposed construction violateI any zoning law, ordinance or regulation: . no 13. Will lot be regraded ...... y.e..s..: ................ Will excess fill be removed from premises: Yes No x 14. Name 6f Owner of premises ...A.n.n.e..H.;..O.1.8.fl.a.... Address I.n.d.~.a.n..N..e.e.k..L.a..n.e.. Phone No....7.~.4.-.6.~ ~ .... Name of Architect .......... . ·; .............. Address .... P.e..eg.n.i.e ........ Phone No ................ ' i Add N Name of Contractor ~ ......... . ................ tess ................... Phone o ................ , i PLOT DIAGRAM Locate ~learly and distinctly alll buildings, whether existing or proposed, and. indicate all set-back dimensions from propel~y lines. Give street and block hu: nber or description according to deed, and show street names and indicate whether interior or corner lot. SeC ,nnexed survey of Van Tuyl ;: STATE OF NEWYORK,Suffolk IS.S COUNTY OF ................. , Anne H. OI~snn (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ...................... ~.. ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and/~uly authorized to perform or have performed the said work and to make and file this application; that all\staten ts cogt~ined in this application are true to the best of his knowledge and belief; and that the work will be peri'ormed in ' : ..... : mtu~ner set forth m the application filed therewith. Sworn to before me this/ d~j~ep No. !~-~,~o0 . .~ / Anne H. Olse n (Signature of applicant) Oualihed ,r, Suffolk Coufit~ Commission Expires Maroh TUT-NOTE GARY FLANNER OLSEN COUNSElLOR.AT IAW P. O. BOX 706, MAiN ROad CUTCHOGUE, I. I., NEW YORK ~i935 TO: i Building Department Town of Southold Main Road Southold, New York 11971 _J Enclosed herewith please find an applicatic for a Final Certificate of Occupancy on Building Permit #12698Z and a separate application for Building Permit #14933Z. Also enclosed is a copy of the Fire Underwriters Certificate #N753927 and two checks each in the sum of $50.00. GFO:af Enclosu SIGNED ~IGNED FEB - 5 1987 DATE' P D HENRY E. RAYNOR. Jr., Chairman JAMES WALL BENNETT ORLOWSieU, Jr. GEORGE RITCHIE LATHAM, Jr, WILLIAM F, MULLEN, Jr, 8outhold, N.Y. 11971 September 14, 1983 ~LEPHONE 765- 1938 Mr. Victor Lessard Building Administrator Southold Town Hall Southold, New York 11971 Re: Gary Flanner Olsen Sit~ Plan at Cutchogue Dear Mr. Lessard: The following action was taken by the Southold Town Planning Board, Friday, September 9, 1983. RESOLVED that the Southold Town Planning Board approve the site plan of Gary Flanner Olsen, located at Cutchogue, subject to certification from the Building Inspector's Office, an on s~t_~ field_inspection by the Planning Board one year review. Attached are three (3) copies of the proposed site plan, along with a copy of approval from the New York State Department of Transportaion for the curb cut. Please contact our office if you require additional formation. Very truly yours, HENRY E. RAYNOR, JR., CHAIRMAN SOUTHOLD TOWN PLANNING BOARD cc: Gary Flanner Olsen By Susan E. Long, Secretary Memorandum from.... BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, ~OtiTFiOLD, N. Y. 11971 765-1802 January 23, 1987 Dear Diane: Pursuant to our telephone conversation of today, I enclose application for Certificate Of Occupancy for Mr. Olsen's office building. Friday February 6th, ]987 has been set for the final inspection. Mr. Horton will be doing the inspection and would like to have Mr. Olsen there. If this is inconvient, please call the office. ~' Thank you, Southold Town Building Dept. Memorandum from... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, ]~OX 728, $OUTHOLD, N.Y. 11971 ~ ^ , 765-1802 Memorandmn from... BUILDING INSPECTORS OFFICE TOW~ OF $OI~THOLD TOM HALL, ~OX 728, SOUTH OLD, N.Y. 1 ] 97 765-1802 TUT-NOTE GARY FLANNER OLSEN COUNSELLOF~ AT LAW P O. BOX 706, MAIN ROAD CUTCHOGUE, I. I., NEW YORK 11935 ,T,O, WN OF SOUTHOLD TO: k gouthold T~n Building Dept. Main Road Southold, NY 1197! Re: Miesner to Olsen File #3486 Enclosed please find an application for a final certificate of occupancy in re the above captioned matter, along with my check in the sum of $5.00. Temporary C.O. #Zl'2527-Temp 3/27/86 DATE: -~Tde~orandum from, BUILDING INSPF-L'TORS Ol~l~lCE TOWN OF SOUTHOLD Tow~ HALI~, Sou'rHOLD, N. Y. 11971 765-1802 PERM 33d (3/81) STATE OF NEW YORK- DEPARTMENT OF TRANSPORTATION HIGHWAY WORK PERMIT APPLICATION FOR NON-UTILITY WORK Application Js hereby made for a highway work permit Gary Flanner 01sen Hain Road - PO Box 38 ~attituck,, ~¥ 11952 1. Requested duration from 19 2. Protective Liabillty Insurance covered by policy No. 3, Workmen'~ Compensation Insurance Policy No. f ENTER NAME AND MAILING ADDRESS IN THIS SPACE _1 thru 19 expiring PREPARE 3 COPIES Highway Perrfiit No, ~ Effective Date , to appJy to the operation(s) checked below: expires on 19 4. DisabiJity Benefits Coverage Policy No. Check Type Permit ~how Ins. Fee in Total Amount Guarantee Fee ~,mt. or PERM- of Feeond/ Deposit Amount of Operation 17 pr Under- or Insurance and/or Bond raking on file $ 20 .... ~[~Demo~litio___n -- ~ Mo~vin~g .............. ~b, Impr ...... tt .... t Department standards .C- -~"~- --~_.J~ *directed (Z~" binder', 1~" ~:0p). TOTAL PAID Work may be described briefly as follows, TO open the No~'th side et~ F/attq Road Rt, 25, approx. 120' west oi~ Hm~bo~ L~.~ Cutchogue, for the purpose of t~stallin) ~t)~ox, 1~0~ of co~.crete cut, b, one 2~' curb cut (nOt tntersecl~ion type dtrve~a.v)~ ~emove and ~eptace extsttn~ concrete sidawalk a~ directed by NYS DOT Pe~it Dept~ install on-.site dratnage'~ restore ~sphalt shoulde~ as* [] Additlonal work description is attached; [] Plans pages and/ar [] Map is filed showing work to be performed at: LOCATION ( F~ ~ ~ State Highway No. PERM 33d (3/81) REVERSE RESPONSIBILITIES OF PERMITTEE PROTECTIVE LIABILITy iNSURANCE COVERAGE F~erm tree must have protective liability insurance coverage in accordance with Department requirements. (See Infor- mation on Protective Liability Insurance Required for Highway Work Permits and/or Special Hauling Permits, Form PERM- 27). Expiration of, or lack of~ liability insurance automatlcolly terminates the perrhit. Insurance coverage may be provided by furnishing the Department with one of the following: a. A Certificate of ProtectJv:e Liability Insurance for permits on State Highways (Form PERM 17, NYSDoT). b. A $2.50 remittance (checkI drawn on a New York State Bank or Certified) for coverage under the Departmental Blanket Policy. c,= An Undertaking may be fu(nisbed by Public Service Corporations and Government Units only and must include the wording required by the D~portment. CO'MPENSATION INSURANCE AND DISABILITY COVERAGE The applicant is requ ired to I~ave compensation insurance and d i sabi [ity coverage a s noted in the provi si ons of the Workmen s Compensat on Law:and Acts amendatorythereof forthe entire period of the permit, or the permit is invalid, NOTIFICATIONS Notify Commissioner, throughI Regional Office~ one week prior fo commencing work, except emergency work by public service utilities which should be reported the next work day. Work must start within 30 days from date of permit, Ndtify area gas distributors 72 hours prior to any blasting. Notify Utility Companies witb facilities in work oreo (permission must be obtained before doing work affecting utilities' facilities) before starting wof, k. Notify land owners of abutfinlg lands, before disturbing trees. Notify Department of Transportation at conclusion of work and return original copy of permit to Regional Office. Annual Maintenance Permit Notifications: Notify by telephone the Distr:ict or Resident Office, one week in advance, each time regular maintenance work is to be performed. In emergencies, notification by telephone should be made the next work day. SITE CARE AND RESTORATION An Undertaking, a bond or ceitified check in an amount designated by the DepartmentofZransportotion may berequlred byithe RegionaI ' Office, before :a permit is Jssued~ to guarantee restoration of the site to its original condition. If the Department is obliged to restore the site of its original condition~ the costs to the Department will be deducted from the amount of theperm ttee s' guarantee deposit at the conclusion of the work. The permittee is respons hie ifor traffic protection and maintenance, including adequate use of signs and barriers during work and evening hours. Anyone working within the R.O,W. will wear an orange vest and hard hat. No unnecessary obstruction i~ to be left on the pavement or the right of way or in such a position as to block warning signs during or between work] hours. Nc) work shall be done to obstruct drainage or divert creeks, water courses or sluices onto the right of way. A/'I falsework must be removed and all excavations must be filled in and restored to the satisfaction of the Regional Tr'afflc Engineer. : COSTS INCURRED BY ISSUANCE OF THIS PERMIT All costs beyond the limits of the protective liability insurance, surety deposits, etc., are the responsibility of the permittee. The State shall be held free of any costs incurred by the issuance of this permit, direct or indirect. SUBMITTING WORK PLANS i The applicant will submit wolrk plans and/or a map as required by the Department. This shall include such details as measurements of driveways with relation to nearest corner, positions of guys supporting poles and a schedule of the number of poles and feet of excavation necessary for completion of the work on the State right of way. A description ofi the proposed method of construction will be included. Plan work with future adjustments in mind, as any relocation, replacement or removal of the installation authorized by this permit and made necessary by future highway mointenance~ reconstruction or new construction, will be the respon- sibility of the permittee. . The permittee must coordinate his work with any state construction being conducted. TRAFFIC MAINTENANCE Traffic shall be maintained byithe permittee on the highway, in a safe manner, during working and non-working hours until con- stJruotion is completed. Suitabl~ safeguards, to reduce conditions dangerous to life, limb and property to a minimum, mgst be pro- vided by:the permittee (includipg flagmen when requested by the Department)· cOST OF INSPECTION AND SUPERVISION If~ in the accounts kept by rite Department, costs of supervision are found fo ~e exceedingly high, the Department re- serves the right to ~ill the' perm/flee fqr aqfua expenses Jncurred by the supervision and inspection of the permJttee~s project, i SCOPE I , : , a. =Ar~as Covered ~ Permits issued are for highways, bridges and culverts Over which the New York State Department of Transportation i has jurisdiction. (Local jgovernments issue permits for their own jurisdict]or{;) , b~ Le~laJ J The privilege granted by [the permit does not authorize any infringement of federal, state or local laws or regulations, is limited to the extent o]f the authority of this_Departmegt in the premises and is transferable and assignable only with the written consent of theCommJss~oner of Transpor_tahon.. c. Commissioner's Reservations, , TheC~ommis_sion&r of;Transportation reserves the right to modify fees and to revoke or annul the permit at any t.ime, at his discretion withoutJa hearing or the necessity of showing cause. d. Locations Work locations must mee~ approval of the Department. (Additional pages to thi~ application vary according to the purpose, and type of work to be permitted) I ttE~,EBY CE[~TIFY, PLANS HA"/[ ,] F4A~~ AI',!~FND~'D - HAY ~, ............. 1 ~rO~ ~ VAN LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOr THiS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (si APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SEt VICES -- FOr APPROVAL Of CONSTRUCTION ONLY DATE. H.S. REF. NO,. APPROVED SUFFOLK CO TAX MAP DESIGNATION: DIST. SECT BLOCK PCL, .*~o'~ o91, ........... ¢ ....... OWNERS ADDRESS: TEST HOLE STAMP SEAL / / :SEe ~d' C .[-' Unauthorized alteration or addition fo this document is a vio]eHon of secHon 7209 of the New York State Education Copies of this documanr not bearing the engineer's inked seal or embossed seal shall no~ be considered valid copies. SITE PLAN *fl i