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Home My WebLink About11021-z BUILDII,4G p, ERMI~1' (TH S PERMIT MUST BE' KEPT ON THE:p~,E4IS~SUNTIL (ULL L1021 Z Date ~O~:,..~.d 19.~/ Permission is hereby granted to: Fee ~$ ..~.. ,~ ..... ~ORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 disposat-(S-9 form or equal). 3. Approval of electrical installation from Board of F.ire 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, 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. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare~ certificate. . ,~ 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... New Building ............. Old or Pre-existing Building(X). _,,)~~ ..... ~/Vacant Land - . ......... Location of Property ......................... . ..... . ........... House No. /~, Street ~ Hamlet Owner or Owners of Property ...... .~.... ,C.~. ............. _ Subdivision ~; Filed Map No,' .~...~'.... Lot No Permit No. ~-~'~ .......... '/~/Z~a~e of ......... .Applica,t ~X;~ ~ '& Health Dept. Approval//~ ~/Z~/ App ' ........................ Labor Dept. royal ...................... ,.. Unde~riters Approval. ~ o ~/, .Planning Board Approval .... . . . ~.~ ......................... , Request for Temporary Certificate Final Certificat~ - Fee Submitte~l $ ............................. Construction on above described building and perr~fft~-nee~s all,,iapp~ca,~le_~codas arid regulations. App cant Ta C O. ,(oq-z I ].000663 THE NEW ~t~ J~,~.~/ 5, 1,982 THIS CERTIFIES THAT YORK BOARD OF FIrRE UNDERWRITERS BUREAU OF ELECTRIGTY 41 BTATE STREET, ALBANY. NEW YORK 12='07 ~ppllcot~on only the electrical equipment as described below and introduced by the applicant Ranted on the above application number in the premises of ~11 C~;'~ ~r~, ~Lr~e. 25~ $ouct~id~ N.Y. i. thefollotving loc. Itoh; '~] Basement ~ 1st FI. [] 2nd Ft. Sectio. Block Lot tvosexamlrtedon ~Ct~ 31~ 19~ andfoundtobeincompliancetviththerequirernentsofthisBoard. 26 26 16 26 DRYERS FURNACE MOTORS APPLIANCE FEEDERS TiME CLOCKS L~NIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R --¥- - I C E OTHER APPARATUS: 2-5 ~5)n. ,A..C, ~i~ HO. Of CC. COt4E*. NO. OF HI-LEG A,W.G. flO, OFNEUTRAL$ A.W.G. ' P[R ~ OF Hr-LEG OF NEUTRAL GlennR. Bradley Rt~ 169, Ik~r'con Ave~ Mattit~cg~ N.Yo 11952 !ic.1227 CoPY F. OR BUILDING DEPARTMENT. THIS COpy OF IN ANY MANNER. COUNTY OF SUFFOli( DEP/~,RTtvlF;~,~T OF' HEALTH SERVICES September 9, 1981 Hr. ~)ean Blaikie Hill Creek Inn ~ Harina iiain Road Southold, New York Re: SPDES Permit No. NY 0130521 Health Department Ref. No. S-qL, Dear Sir(s): Enclosed please find the State Pollutant Discharge Elimination System Permit for the above referenced job. Please carefully read the "Other Conditions" and note that the permit expires in five (5) years. This permit should be kept available on the premises of the discharging facil- ity at all times. Very truly yours, Robert A. Villa~ P.E, Chief General'Engineering Services RAV: ljr Enclosure Suffolk County Department of Health Services PERMIT 02549 To Operate A Service Food Establishment Dennis M. Blaikie the operator of a service food establishment known as MILLCREEK INN located in lhe Main Road, Southold Town of Southol d in Suffolk County is granted this permit to operate the above-named service food establishment, as provided by Article 13 of the Suffolk County Sanitary Code. This permit will expire upon the change of the operator, or as otherwise determiaed by the Deparlment. Ii is not transferable or assignable. It may be suspt,nded or revoked as provided in the Suffolk County Sa~fitary Code. It shall be posted conspicuously on the premises and made available by the operator on request. This permit is granted subject to any and all State, local and munlcipa] laws, ordi~mnces, codes, rules and re~lations. Date October 6:1981 Form EP-IO 18-660: APPLICATION FOR&~I "D" FOR A STATE POLLUTANT DISCi~^RGE ELIMINATION SYSTEM (SPDES) FEP, k, IIT (Becomes A SPDES Permit Widen Signed By Permit Issuing Official) 'F Y - FER ALL CORRESI'ONDENC[ TO: (Na~, l,tJe andes) -~ "~/< ~ l'U y /~ 2 / f,L",.. 1YPE OF OV~NCRSIIIP [--~.~(orporate ~ Indi¥1dual ~] Partnershm L] Pub! YOUR DISCHARGE CONTAIN OR IS IT POSSIBLE' FOR YOUR DISCHARGE TO COhTAIN ONE OR ;,tORE OF THE FOLLOWING SUOSf ~',NCES ADDrD AS A RESULT OF )UR OPERATION5, AC [IVITIES OR PROCESSES] t~ C,r£.ase [] Lead [] M('rLury ~ Nickel ~ Oil fl Yes ~ Na ' :~Y~-~ TREATMENT JIFALL hO.J ~] Propobed L] Replacement TIYrL C}k Y~ASJE J.[] Ex~l.l~ [] Expansion [] Y~s [] ~o J ~BSUREACE DISCHABGL If"Ye~", Name of nearest Sullace Y, aJer NO. DEs ante r SOIL TYPE . ] ~'YPE OF TREA1 MENT jClasslf,catlon jWal~rs Index NO, tRFACE DISCHARGE If "Yes", Name of Recetwng ~aters [] Ye', ~ No I Distance .. SOIL TYPE DtptB lo Y. ater Ta jClassit,catmn iv,'.ters Index No. This SPDES permit is ~ssued in comphance valh T~tte 8 of Amcle 17 of the Enwronmental ~972, P.L. 92-5C0, Oclobe~ ]~, ]972 (33 U.S.C. ~1251 et. seq.) (he~ema~er relerred tO as "the Aci~N-.and-$ubject to the ~ttached cond*tlo~. - - ,.. C ~,:;~,' ('] ~,,' .......~' .51 115~W,.tt,:l' II I[ / [ I Il II NY- 018C521 EFFECTIVE DATE 9/9/8~ "0tiler Conditions" :ARD latitude 58 59L°nglltude._~_.~ tgi CARDT__ 57Lira ' FIELD INSPeCTiON COMMENTS FOUNDATION (Ist) ~OmVO~TION (an~) ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE EN?RGY CODE FINAL ADDITIONAL COMMENTS: Memorandum from.... BUILDING INSPECTORS OFFICE town oF SOUXaOLD TOWN H^L~-, SO~TaOLD, N. Y. 11971 765-1802 2. 3. 4. 5. 6. 10. 11. 112. 13. ,~hat design and construction of all sewage-~nd waste disposal systems be in accordance with the applicable standards of the Suffolk County Depart- ment of Health Services. That use of the disposal facility not take place without the written approval of the Suffolk County Department of Health Services. That the system be maintained to the satisfac'tion of the Suffolk County Department of )(ealth Services. That no industrial wastes be disposed of into the sanitary system. The applicable groundwater standards not be violated. At the discretion of the Suffolk County Department of Health Services, a means of flow measurement of wastes shall be provided. That a representative of the Suffolk County Department of Health Services shall inspect the excavation, construction, and backfilling operations for all non-residential sewage disposal facilities to ascertain that the system has been constructed in accordance with the approved plans. That the approval of the waste disposal facilities does not constit~te the approval of the structural stability oF the system by the Suffolk County Department of Health Services. That if change or revision to the approved plans are contemplated, such changes or revisions are to be SU~litted in writing to the Suffolk County Department of Health Services prior to any further approvals. That the sewage disposal system is designed and the permit issued for the following type building restaurant . Any change in use or occupancy other than that initially approved (e.g. dry store to a wet store) will require a new submittal of plans and sDecifi- cations to the Suffolk County Department of Health Services prior to said change. ~ ? In the event that a municipal or communal sewage disposal system or facility connecting therewith becomes available, any building or premises shall be connected to such municipal or cemmunal sewage disposal systems and immedi- ately thereafter the use of any other sewage disposal system or facilities shall be discontinued. Where plans and construction have been approved for the installation of.a private well supply, and subsequently a public water source is made available, said building or premises shall connect to such public water source and the use of the private well supply discontinued. That if transfer of this permit and its attendant obligations to another permit- tee is desired, the pemlittee of record and the assuming permittee shall so petition the Suffolk County Department of ~ealth and the New York State Depart- ment of Environmental Conservation in writing. Transfer shall become effective on the date prescribed 'in the written notification of such transfer to be furnished to both the original and the assuming permittees by the Hew York State Department of Environn~ental Conservation. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined n./.q. ..... ,19 .... ........... .......... / ..................................... ~ .... .~zz~ (BuildJn~ [nspector) APPLICATION FOR BUILDING PER~IT Application No.. ~ ./.~.'.~./. ....... INSTRUCTIONS a. Tills application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 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 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 and in buildings for necessary il~p~tioj~s. ~ J/ · ~S~g/na~e 6f applicant, or name, if a corpon/tioq) (Mailing address of~3ppli~capt), State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , (as on the tax roll or latest deed) If app, l~ca~ is a~corpo~c,atiop~ signature of ~uly authorized officer. (Name and title of corporate officer) Builder's, License No.../~Sf f'~ /~'FV~ ~ Plumber s License No~.. Electrician's License No.. ~.. ~¢.;q~ ~cp. Other Trade's License No ...................... 1. Location of land on which proposed work will be done ...... ~..~..&7~ .~d .... . ./t~....~.//.~.~. .. .~:1 ..... ....................................................... h House Number Street Hamlet County Tax Map No. 1000 Section .... ,.~:,,. .......... Block ...~..~ ............ Lot. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ,t~_,~,',~. ~/..~.C/.~.~?? tiT. ............................ ................ b. Intended use and occupancy ....... ?../.? .~?. ?= ..... <~?: .7.~.~..~..7-/.O.'. ......................... 3. Nature 0fwork (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work .............. (Description) 4. Estimated Cost .............. ' .... , ............... Fee .O( .M= ............................... (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 mixedloccupancy, specify nature, an¢ 9xtent of each.tyjpe o~,use . . ~. ~.'X/.~F.~. -r~ ........ 7. Dimensions of existing structures', if any: Front .... ~.,...d. .... Rear ...~. ~i'..~. ..... Depth ....~..d ........ Height . . . 2-.~. .~ ........Number of Stories ...... .2. ................................................ Dimensions of same structure w~th alterations or additions: Front .. 8. Dimensions of entire new construction: Front ...~'~F..,f& f ..... Rear .. ~'.~.~. F ...... Depth .. ?..,fl=.~.~. [ ..... 9. Sizeoflot: Front . · i .......... Rear ...................... Depth .... , ....... 1 I. Zone o~ use district in which premises are situated ........ ~... ~z~.w'7....-~qE .r.~(..~7~. ~.., .................. 12. Does proposed' construction violate any zoning law, ordinance or regulation: ........ .'Q'. ~. .................... 13. Will lot be regraded ......... ,4-/..(~ ............... Will excess fill be ,removed from premises: Yes No Name of Architect .......... ; ................ Address .................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. ~ STATE OF NEW Y~_K,/,d / JI 'S S COUNTY OF..~~..~., · .... ././~...~,. <~.' ?.-7_/.~.. _ .~,~./?.r.i ~.~ ............... being duly sworn, deposes and says that he is the applicant ~(Nanle of individual signing contract) above name . He is the ~'~/'~-~/~ 7 : ~ ........ : ............ .~ ............... ~: .... · ............................. i (Contractor, agent, corporate officer, etc.) of said owner o'r owners, and is duly authorized to perform or have performed the said work and to make and file this application; tha~ all statements contained in this application are true to the best of his knowledge and-beliefrand that the work will be performed in the manner set forth in the application filed therewith. Sworn to beforelme this i '"--- ~7'( ' ....... ~../?....day of....~.-~.'~./..~ ............. 19 ?.!. Nota, rry Public, . ..... ,~x ...... ._. ~,,... ounty .~[/ ELIZt~B~Tlt ANI~/NEVILLE (Signature of applican t) ' . ~IOTARY PUBLI(I, State of flew York No, 52-81258501 Suffolk Term Fxpires M~arch 30, 'lb GLO. ~Ox4, '0 -o 4 4.Lc¢ -- .... 2%.4° ~r- (- ~/9- P/~I:L"TIT 101,4 I,~s c~o ~T F 4Li" '-- IL?-" b ,4" II I I ~ T -- FI~AD t2,oo¢¢* q T'~,£ouedto(,,T DECI~. " % OCC~?~,[ICY 'OR lie ~ifl~f CEEflFiCATE OF OCCUPAflC¥ 765' Mu.s% ,, N.Y. ALL FOR COD~S. ~ I I 4': ~A/?~'H. r-IRE.P~OOF 5 NE~"T~OCK , 1~6~'- . , -- ~" ~N, ~ N~T~, t'' a: , ~ _~,_ : , 'e, e