The URL can be used to link to this page

Home My WebLink About11299-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... Z ~ 5&9.0 ...... Date . .]~.e. mbe r..~.Q, ................. 19.8.6. THIS CERTIFIES that the building , .~ ?,p,a, ~ .~.,..a. ~ d ± t z o..n a n d c o n c v e t e s 1 a b LocationofProperty74.8.2.~ .M.a.$.n Roa. d ' 9r.e. enpo.r,t~ .New York House Ho. Street Hamlet' County Tax Map No. 1000 Section...,~,~ ...... Block . ...4.. .........Lot ....... .7.... .... . Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4u. ~y..2.7~ ............. 19,8.1. pursuant to which Building Permit No...1.].~.9.9. Z. ............ dated .4¢ ~Y..~ ? ~ .................. 19.8.h, 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 ......... ~e p.~.,..aA d. $.~.~.q~.. ~.n.~.. c. 9 p.q~.e..~.~..~. ~..<~..~.o...%~.~. s..~.~.~.~, r.~.~.~.a..~ rAq ~...~.u.~. ~..d 5.n.~ . The certificate is issued to JAMES P. & BRIAN K. KAVANAGH (owner, ~7~og ~X X of the aforesaid btfilding. Suffolk County Department of Health Approval . ???.m..i~. jr. 0..6.~.~.7...C.l.a.s.s...C.o.d.e...1.q ,...1 p./.~.0. / UNDERWRITERS CERTIFICATE NO ......... ?.e,q cl. ~_p_g ................................ Building Inspector Rev. 1/81 N°. TOWN OF~ ~OUTH~D BUILDING DEpARTMJ~N TOWN HALL SOUTH'OLD, N~ BUILDING FEIU~IT (THIS PERMIT MUST BE KEPT ON THE P~E/~I~ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED), ~s9 z Do,e ..,., ................. ..J..~g.Y.....~ ....... ,9..~../ Permission is hereby granted ,to: · " .................................. tO ..................................... ~ ....................... ' ..... ....... ~ ............. I .................... · r:~;.~;~.'."~'""~ ~"/~L:D~'""~ %'"'"~'~'~ ~'""~ ~' . .U ." 7~/~/~/~ ~o^~ ..'.. . at premises IOCO~ea or ............................ ~ ............................ ..?--.? ................- ................................... ..................................................... ~..Le.~.!v ~.~... County Tax Map No. I000 S~ction ........................ Block r'"'~i ........... :~Lot No ..................... pursuant to application dated ..................................... 19. . and approved by the Building Inspector. Building !Inspector Rev. 6/30/80 TOWN OF SOUTHOLD Building Deparzmen~ Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 1-n.s caohcotlon must be filled in typewriter OR ink, and subr~itted ' ' - ~n duphca,e to the Building Inspec. tar ,.'z~n the follow~ng; for new buddmgs or new use: ~. F'.n¢l :u~.'e,/ of propart,/ with accurate Ioc~t,on of aH buildings, property lines, streets, and unu~al 2. Fmo¢ .,:~orcve~ of Health east. of water sdoolv and sewerage dtsposa --{S-9 form or equal). 3. ~¢3~c,'~ o~ eiec~r,cal ms,allergen from Baird'of Fire Unde~riters. 4. Commercial build~ngs, Industrial buildings. Multiple Residences and similar buildings and installa. t~ons, a coruflcat8 of Code compliance f¢om the ArcMt8ct or Engineer responsible for the building. 5. SuomK Pl3nnmg Bo~rd approval of comple(sd s~e plan requirements ,,,/here appt~csble. B. For ex,sim3 buddings (prior to April 1957), Non-conformin¢ uses, or buildincs and "pre-existing" land uses - ~.Accura[e suwey of peoperty sho~vmg ail prooerty lines, ~reets, buNdinos and unusual natural or 2. Sc, o:~ s[c~m~R~ of owner or previous owner as to use, occupancy and condition of buildings. 3. Dz~e o¢ ,:ov housing code OF safety InSpection of buddmcs or premises, or other pertment mforma. Co 1. C~.,,ca,. of occupancy $5.00 2. Cor:'f.ca.e of occupancy on pre-exIstmg dwelhng or tend use 3. Ccny at certificate of occupancy $1.00 $5 00 , ~7%£a ¢ -'F~2;~'.Z. ~ ~' .... I ..... = ~n~ ~na ............ . - ........... ~ _/ ......................... Court:,/ Tax Mae No. 1000 Section B o~ / Subdtw~toq ., .............................. Filed Map No ........... Lot No. , . ..... , ..... H~aith Dep[ Approval ........................ Labor Dep~.Approval ....... Un~cn, zr,,~rs Approval ........................ Plannmg Board Approval ................. Request ~or Temporary Certificate . . · · .Fmal Certif~cat8 F~e SuDm~ttzd S ............................. .::,,~ ,~;:~j4 ...... , .... .. DIVISION OF PUBLIC HEALTH / ~,\~ ~ APPLICATION FOR FOOD ESTABLISHMENT PERMIT (To be submitted at least fifteen days before the first day of operation or at least fifteen days prior to the ex- piration of an existing permit) OPERATION OF A FOOD ESTABLISHMENT WITH- OUT A PERMIT IS A VIOLATION OF THE NEW YORK STATE AND SUFFOLK COUNTY SANITARY CODES. (Please Type or Print in Black Ink) Disability Insurance No: Company: Worker's Comp. Policy No: Company: (FOR OFF,CE USE ONLY) PermitNo. O~,'L//¢'~, ClassCode. Date Issued~F-~pira~n Date Permit Aooroved B;/:,,r~_ ~. ,~ .~ ~-~-- Permit Conditions ~f~ Le~er Name of Establishment -~2~/~ / ~, ^~ .c~ ~ cr ~/~' Tel. No.: Name of Owner, L,s~ or Ocra,o, ~/~* /C ¢~*'*,~/ ~Tel. No.: Mailing Address '~O~ 7~ 4 ~ ~ ~'~.~ ~ ~ Zip Code: Type of Establishment (Restaurant, Deli, Caterer, etc.): '~ // ~;~ ~4/~ Permanent ~ ~asonal.__ If temporaw (less than 2 wks.) s~ci~ dates No, of Food Handlers Seating capaciW at counters Type of Ownership: Individual ~ Partnership If corporation, enter name, address and phone no. below: Address: Phone: At tables ~ Corporation /'~ Non Profit If signature is officer of corporation, enter home address and home phone no. below: Address: ~"~/~ -~ Phone: Floor Area of Entire Establishment ~,'~/, 00 .2. ¢0 o sq. ft. Dining Area only sq. ft. Mobile Units and Vending Machines, attach itinerary and answer the following: 1. If a mobile unit, enter Motor Vehicle License'Plate No. '--' Year & Make 2. Name, address and permit no. of establishment(s) where food is prepared and stored: 3. List type of food sold THE APPLICANT HEREBY AGREES TO OPERATE THE FOOD ESTABLISHMENT DESCRIBED ABOVE IN COMPLIANCE WITH THE REQUIREMENTS OF THE NEW YORK STATE AND SUFFOLK COUNTY SANI- TARY CODES AND HEREBY AUTHORIZED REPRESENTATIVES OF THE SUFFOLK COUNTY D_EPART- MENT OF HEALTH SERVICES TO FULLY INSPECT ANY AND./~LL PERMISES AND TO__TAKE J~MPLES OF FOOD THEREFROM. Signature ,~¢%~, ~/~'~' Title~'~ Towns of BABYLON, HUNTINGTON, ISLIP and Towns of BROOKHA~N, EAST HAMPTON, RIVER- SMITHTOWN, return this application to: Bureau of Environmental Health Division of Public Health ;?5 Davids Drive Hauppauge, NewYork 11787 Form No. BEH 28 HEAD, SOUTHAMPTON, SOUTHOLD and SHELTER ISLAND; return this application to: Bureau of Environmental Health Division of Pub$ic Health Riverhead, New York 11901 18.525 ACTION CONT [~] NEW ~ CHGE [~] DELT E~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES (..,).~u~----.~o FOOD ESTABLISHMENT INSPECTION REPORT PAGE OF FOOD PRO- TECTION ' co.P EST^., NUMBER 107' I [ · ~ I DATE 105' [ 0 INSP. 106' PM DATE 31' [ { I I I Original container, properly labeled 114 , I [~l~J NSP. TOILET & HANDWASH FACLTS 143 ACTION CONT ~ NEW ~ CORPORATION ADDRESS 15~ ACTIVITY CODE 101' CHGE ~ DELT [~ "-'/~ PI.ri. ~ P C~1¥ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOOD ESTABLISHMENT INSPECTION RE?ORT DATIE 105' GENERAL FO00 POOD PRO- TECTION FC-! 5/79 SEWAGE PLUMBING PAGE OF CODE FLOORS WALLS & CEILINGS LIGHTING VENTLTN. DRESS RM fines. Relnspectlon Date 18-519 318 Na(~e o ent, FOOD ESTABLISHMENT INSPECTION REPORT Date Remarks Item No. FC-2 Page Date Violation Corrected ..... '~Ou C~ I---! from.... BUILDING INSPECTORS OFFICE TOWN OF SOUT~OL~ TowN H^LL, SOUTHOtV, N. Y. 11971 765-1802 TOWN OF SOUT~OLD OFFICE OF BUILDING INSPECTOR · P O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 1 t971 TEL. 765-1802 This is to advlse you *hat th ' ~ 'e ' -' - Fermit.No. ;;o.q~ issu~ e ~o~ u..s r Bul!d~n~ ' - ~ *~ no~ been done. In oreer to complete oh_s rile it is necessary that - O ~-..cy be issued. F~eas= fill o,,t the enclosed ~ ~ - - ~ · or.~(s), return same to ~he above ~r, ~ o_. -c_ with a check for $5.00 payaoie to the Town of Southo!d. Please indicate to whom the Certif%cate of Occupancy is to be nailed, and arrange wzth this office for an inspect'ion date. Thank you for your prompt aztention. VL:ec Enclcsures Very truly yours, Victor Lessard Adminis 5.r~ FO~M NO. ~ TOWN O? $OUTHOLD Bu~Jdiag Deper~men~ Town Hall SouthoM, N.Y. 11S71 APPLICATION FOH C~RTIFICATE OF OCCUPANCY instructions A. Tn,$ ?DOJ,,Cat~orl must be filled in typewriter OR ink, and submitted in duplicate to the Buiiding Inspec- tot ,.v~m ~,~e ;allowing; for new bulldogs or new use: 1. F aa} :up,'ay of property with accurate location of alt buildings, property lines, streets, and unu~ai 2. Fina~ ,'::crcval of Healt,h Dept. ot water supply and sewerage dispossl--(S-9 form or equal). 3. ~*¢:::c,.al o~ e!ec~ncal msteNat~on from Board of Fire Under~vriters. 4, Commercial buildings, Industrial buildmgs. Multiple Residences and similar buildings and installa- tions, a czr~lf~cate of Code compliance from the ,Architect or Engineer respons;ble for the building. 5. Sue-m~ ?lanmng Board approval of completed site plan reqmrements ,,,/here apphcable B For existmg buildings (prior to April 1957), Non-conforming uses, or buNdincs and "pre-existing" 1, ,~,cst;ra[e sup/ay of peoperty showing all prooerty lines, streets, buildings and unusual natural or ~o u_e, occumancy and condition of buildings. 3. Da~z or ,,n',' housmg code or safety inspect/on of ' ~ r ' 1. C.~,,,ca,_ of occupancy $3.00 2 Cor:'Lca:a of occupancy on pre-ex~s~mg dwelhng or land use 3 Cc2,,' of cert~frcate of occupancy $1.00 $5.00 ~ _ ............. Old orPre-e×[szingSudoing,{Z) ..... =rVscant Land ............ ..... ....... Owner or Cwners of Property .... ' . Court,/ ~ax ,',h-..o No. 1000 Section ............. Block ................................. FHed Map No ...........Lot No. ¢.f .......... Heahh D,2~ Approval ........................ Labor Dept. Approval ...................... ,.. Unuer.'/r~ters Approval ....... Plannmg Board Approval .................. ~ .. ,. Request for Temporary Certificate .................... F hal Cartel,cate Fee£uDm~ttad S ............................. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL . SOUTHOLD, N.Y. 1197'1 Examined ~ 9 Approved ...... ,i : :~'~l ......~.., 19 rmit No ...... : ..... Application No. / ' ~' -' Disapproved .... :....~Y.:'.~ ........................ ...................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stie~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap[ cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No buildiug shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections./__ //~ ,,,/ ~Signature of applicant/or name, if a corporation) ..&..'.'~ , .,C. " ' ~ ~ (Mailing address o£ applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nane of owner of premises , I~/'}/'~ F. , ' /~..r/~ ' /'/-2C ~IVt9 , ' (as on the tax roll or latest deed) If applicant i~ a. oor~ration, signature ~f d~'y attthorized officer. ...... ~.....,.X. ..... ; ..... : .................... (Name and title of co,orate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No...' .................... Other Trade's License No ...................... Location of land on which proposed work will be done ................................................ .. '. f . . .-: ................ .... Ho~e Number Stre;i ...................... '~/t~n'l;; ...................... County Tax Map No. 1000 Section ~/ 'f :'" - ' .................. Block .................. Lot ................. Subdivision ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy / z ,' /', b. Intended use and occupancy .................................................................. L Nature of work (check which applicable): New Building .......... Addition ...... Alteration .......... Repair .~. .......... Removal ............. Demolition .............. Other Work .~ , (Description) ~ Estimated Cost 2~c~o f'~ ~o Fee i (to be paid on filing this application) If dwelI'ng robe of dwelli g fin' Nu nber of dwelling units on each floor {, I ~ nu r n its ............... t ................ If garage, number of cars ..... . ................ ., .................... t ..... i~" '/~.~ ................. i. If business, commercial or mixed occupancy, specify fit~ture and extent of each ype o e . :si ./'¥~'.td.,f~.~//.~. ...... ~. Dimensions of existing structure~, if any: Front ..... : .3.0. ...... Rear .... 3.°. ....... Depth ...'~..~ ......... Height /?. ~ Number of Stories / Dimensions of same structure wRh alterations or additions: Front ................. Rear .................. Depth I Height Number of Stories ~. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ........... , .... Number 9f Stories ................................... i/?~,. ................ L Size oflot; Front .~.'.2:~:f/.,.~.4~.'. ....... Rear ....2..~..¢.,.2..d.~ .........Depth ............... ). Date df Purchase ............................. Name of Former Owner ............................. in which pre'raises are situated 1. Zone or use district ..................................................... _.>Does proposed construction violate any zoning law, ordinance or regulation: .. ......................... ... · · 3. Will lot be regraded ......... . ................... Will excess fill be removed from premises: Yes No ~.'Name of Owner of premises . . .~ ......... Address ................... Phone No...~.7,7., ,~. 0. ,-g.(.. Name of Architect ............................ Address ................... Phone No ................ Name of Contractor ......... ~ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all'buddings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ,terior or corner lot. rATE OF NE.~. OI~K~'~ .~ ~ , S.S OUNT¥ ~ being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) )ove named. e is the ..................... i ................................................................... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this ~plication; that all statements contlained in this application m'e true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth h~ the application filed therewith. worn to before me this., z~ i - i Commission Exp,res March 30, J.9,t~..~) , r ~tmgnature OI appneant) i ~, FOUNDA~-!ON - TWO REQUIRED I~ FOR POURED CONCP,'ETE ')' ROUGH - FP, AM~NG & PLUMBING 8, IN~SULATION ~' FINAL CONSTRUCTION MUST ~~d~ON SHALE MEET THE REQUIREMENTS OF. THE N,Y. ~AZE CONSTRUCTION & ENERGY CODES NOT RE~PON:S]BLE DESIGN OR CONSTRUCtiON ERROR~ AS NOTED . ~/ B.P. ~ NOTIFY BUIL~ DEPARTMENT AT m ~, v~u~ r~u~ c~. 765-1802 9 A~¢~ TO 4 PM FOR THE FOLLOWING IN~ECTIONS' E+ /v¢'~ //''/ ,4-' ........ /?,/I N ¥ State Lie. Lan~,$urveyor L,ICEN~ ,I~IE LAND No, J. Fi, 6EIDEMAN bAND suRvEYOR 2~,~-~>)