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HomeMy WebLinkAbout11025-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y, Certificate Of Occupancy No. Z10505 Date May 2a ., THIS CERTIFIES that the building ................................................ 43715 C.R. 27 Middle Road, (C.R. 48) Location of Property ~ds~ ~o7.8, .5..HOI~,O. II-~. LEt. ........ Street~°Jgth°~'l;]' County Tax Map No. 1000 Section .0.~t ........ Block .... .0.3. ........ Lot ....0.3.0. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .J .a.n.u.a. ? y..2. 6. .......... 19.8. 1. pursuant to which Building Permit No ...... ! 1. .0 .2.5...Z ........ dated ... F.ebvu&~.~t. 3 ............. 1 fR.1.., 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 ......... Sandwich Shop. Sandva P. Rave The certificate is issued to ........................................................... (owner,.~e.~ee.e.r~er~tt. of the aforesaid building. Suffolk County Department of Health Approval'. ...... P.e.n..d.i.n.g. ........................... UNDERWRITERS CERTIFICATE NO .... ~;~1,~ x...N 522.Q 25 .... / ................... Building Inspector Rev. 1/81 FOEM NO. 2 TOWN OF SDUTHOL~ BUILDING TOWN HALL SOUTHOLD, BUILDING F*EIU~IT (THIS PERMIT MUST BE KEPT ON THE P~,EM CGMPLETION OF THE WORK AUTHOR[ZED) 11025 7 IS~S UNTIL ~ULL Permission is hereby granted ....... to: ..... ~...~ '~ ~ ...~, ~. z~.....~,.....L~, ..~, ....... ~.....~ ............. ~ ......... ~...~. ...... z...? ~.. ~/~. ~':-~ .7. ~ ~.~. ~z~ ~ ~...~,....~ .......................................................... : { ~ ~ t ~ , ~x ~.~ ~ ..~ ........................ ~,.~,~.,o~.~.~.~..~..z.~ ........... ..; ........ x....~ ~ .~....~ ...... :..FE..,.~.~../~.~..~; .......... ~~z~.~.~. · ............ / ~ Tax M~p No. 100~ S~ctio~ ...~. Bilk ?., ~ ........ :~L~ No ............ Buil~lng Inspector. Rev.,6/30/80 FORM 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 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 bu~idings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ........ .~..~..~z~...I.~..I ...... New Building ............. Old or Pre-existing Building . .~. ......... Vacant Land ............. Location of Property /'-~;~-7/'5~/~J°rz-')~¥~ .(-~.. ..~.~.~?..~..~.1.~ ~J .~ '..(.!.(~.'7] House No. Street Ham/et Owner or Owners of Property ...~..~... ,'~...P'-~... ?.; . .~.. ~ .~....~. ,~.~ 9.C..~..~..L4J.J.. ~ ..... County Tax Map No, 1000 Section .....~ ......... Block -~ Lot,. Subdivision .................................. Filed Map No ........... Lot No .............. Permit No.. / .1. ?. ?~. ?./Date of Permit .'?.J ~. ! ?.~ ~..../'~..~ · . .Applicant .... ,'~,/~"~J, ,~,, ,/~,,.. ".. .~, ....... Construction on above described building and permit meets all ap~l, icable codes and regulations. Applicant..~:. ~ ......................... Rev. 10-10-7S 10oio71 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC TY Y ,3~.:~ ~, ~.gsl ,,5 ~o.~ STREET, NEW O.'~ ~,,~3%~RK_ ~O~. THIS CERTIFIES THAT only the electrical equipment ~ described belo~ and introduced by t~ applicant nan~ed on ~he abo~e application ~umber in t~ premlses of in the followlng location; ~ Basement ~ 1st FI. ~ 2nd Fl. Section Block Lot FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: E R V I C E A, WG PER ~ OF CC, COND NO, OF HI-LEG A, W, G OF HI-LEG NO, OF NEUTRALS OF NEUTRAL 215, ' .goud~)ld, N.Y. 119'/1 inspectors may be identified by their credentiaJs, .OF IN MANNER. This certificate must not be altered in any manner; return to the office of the Board if incorrect. ACTION CONT ~ NEW ~ CHGE ~ I DELT [~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ~ZP~.~f,~2--'~;~ PAGE · OF FOOD ESTABLISHMENT INSPECTION REPORT I OWNER'S NAME 13' CORPORATION ADDRESS 15~ ~) FROZEN MGR. CERT. NUMBER 107' GENERAL Valid health permit Economic Violations FOOD Approved source, wholesome, Original container, properly labeled FOOD PRO- TECTION POOD EGUIPMENT & UTENSILS prepar., display, service~ transport Adq. facilities to maintain product temperature Potentially hazardous food properly Unwrapped & potentially hazardous food transport PC-1 5/79 Name of Establiehm~nt Itam FOOD ESTABLISHMENT INSPECTION REPORT Remarks Date Violation Corrected FC-2 Page ~ of 2, ¥. Scdf~: "qO '=' I" // FI~ IN$?ECT~0N COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENTERGY CODE FINAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... 2 " [ul lng inspector) APPLICATION FOR BUILDING PERMIT Application No../..~.~.. ¢.5 ........ Date...I ./..~-: .~. .......... i97.£ INSTRUCTIONS a. This 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 othefapplicable 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 inspections. (Signature of applicant, or name, if a corporation) .... ~.'..~.~. !~ ?..*...~.v..~. ,re. ~...~. (Mailing addresst of applicant) State whether applicant is owner, lessee, agent, architect, engCneer, general contractor, electrician, plumber or builder. .. .... ~w..~..~, .,~.. ~..~..,, .~...x:.~ .................... Name of owner of premises. .~. ¢~...'.&....~.~...L:O~. . . ~/ ......... 6 0 (5 ~ g-..~....~..~.c~ .(.g~...~.......L~.....~.~ ....... (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 ........... .,~,~ .......... lumber s License No. fCt. ~_ ~_~4 z~q~.~_-.~.... Electrician s License Nor ............. If ....... / '("N Other Trade's License No ..................... ~ 1. Location of land on which proposed work will be done...~-q~.. ~.. ~... ..... .r,. ..................................... House Number Street Hamlet County Tax Map No. 1000 Section ./¢.°.°.7....~.~ ...... Block ~ .... .~. ..... Lot... BO. ............ 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 .... ~ .... ~....L~...~ b. Intended use and occupancy ....C..~..._.~..'.' .---~qK~...~...t~..~..-r .~O,.~ .~...CrC~.. 7..V~.. ...... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration,,~. ....... Repair ~ ............ Removal .............. I~emolition .............. Other Work ............... ~% ~ ~ (K.~J~o, (Description) Estimated Cost .... ~)...q ..... .Sj ~ Fe .......... (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .... ~}. .............................................. ! .... ha '? 'tx ....... If business, commercial or mixed occupancy, specify nature and.extent of each type of use .~ ........ Dimensions of existing strncture~, if any: Front ./9..~.. ~ear ~ .~ .~: Height ............... Number of Stories ..... I.~.. I~.g- ......................................... ... Dimensions of same structure with alterations or additions: Front ~21:n,2~ ......... Rear .................. Depth .................... :.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ......... :.. .... Number o[ Sto~ies.~ ....................................................... 9. Size of lot: Front .~.12~l~.~Rear ...................... Depth 10. Date of Purchase ............................. ~ Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated .......... .~. 7.( ....................................... 1 2. Does proposed construction violate any zoning law, ordinance or regulation ................. 1 3. Will lot be regraded ..................... Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises ...: ................. Address ................... Phone No ................ Name of Architect .......... : ................. Address ................... Phone No ................ Name Of Contractor ......... : ........ .......... Address ................... Phone No ................ PLOT DIAGRAM ~ Locate clearly and distinctly all ,buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATL OF NEW YORK, :S.S COUN~TY OF ....... 2 v% ....... · : .~o~ ~}~2r~...l~.: .................... being duly sworn, deposes and says that he is the applicant (Name of individual sign!rig contract) above named. ~He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulk authorized' to perform 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 mannelr set forth in the application filed therewith. Sworn to before me this ................. ' · ~.~1 .day of ....... .'~..~ ~ .... , 19... Notary Public, ...... .~..~...~.~ .... .?County a~rg Public, St~ate of I%~ ~ , . ..~,~, .~ ...................... No. 30-4602404 (Signature of applicant) ~Ul~lfiefl In Nassag C~ml~ ~,~ml~l*m expires Mar, $0~.