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~.