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HomeMy WebLinkAbout26204-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27062 Date: 05/01/00 THIS CERTIFIES that the building ALTERATION Location of Property: 31525 MAIN RD CUTCHOGUE (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 97 Block 5 Lot 12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 1, 1999 pursuant to which Building Permit No. 26204-Z dated DECEMBER 3, 1999 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 INTERIOR ALTERATION TO EXISTING COMMERCIAL BUILDING FOR PIZZARIA AND RESTAURANT AS APPLIED FOR. The certificate is issued to NATHAN L SEROTA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL C10-99-0015 03/07/00 ELECTRICAL CERTIFICATE NO. N-515999 02/22/00 PLUMBERS CERTIFICATION DATED 03/01/00 HARDY PLUMBING & HEATING - �'4 )- '��? ut rized Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26204 Z Date DECEMBER 3, 1999 Permission is hereby granted to: NATHAN L SEROTA 70 E SUNRISE HIGHWAY VALLEY STREAM,NY 11581 for INTERIOR ALTERATION TO AN EXISTING COMMERCIAL BUILDING AS APPLIED FOR. at premises located at 31525 MAIN RD CUTCHOGUE County Tax Map No. 473889 Section 097 Block 0005 Lot No. 012 pursuant to application dated NOVEMBER 1 1999 and approved by the Building Inspector. Fee $ 400 . 00 Author ed Sigo&ture ORIGINAL Rev. 2/19/98 _ Form No. 6 �" ,TII �T�� i' f TOWN OF SOUTHOLD 4 f o V a 3 Q _ir1 BUILDING DEPARTMENT TOWN HALL d 765-1802 L t F;I_DG. F'Ci'T. Ty^rv'µ AYIYLICATION FOR CERTIFICATE OF OCCUPANCY A. 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. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: el. Accurate survey of property showing all 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. C. 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - .25C, 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . /' Old 0 Pre existing Building. . . . . . . . . . . . . Location of Property.3��."�.�� . . � �. . 1:�. 1(Y. .� . . . . . . . . . . . . . . .li House No. / �` Street �/ Hamlet Onwer or Owners of Property. L r � � .(. ( • . . �•[.". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • County Tax Map No 1000, Section. . . 1.7. . . . . .Block. . . . . . . . . . . . . .Lot. . . ./.04 . . . . . . . . . . . . . Subdivision J✓// 1.�✓5 � �t . .��•4�1r . . . .Filed Map. . . . . . . . ./e. ... ..Lot. . . . . . . . . . . . . . . . . . . . . . Permit No�iJ.a.o.q. . .Date Of Permit. . . . . . . . . . . . . . . .Applicant op'CiGs7 r a�27 Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . z. . Fee Submitted: $. � .-. 8 d. . . . . . . . . . . . . . . QRC S�$O�j 4-e . . . . . APPLICANT. . . . . . . . . . . . . . . . . . . . . . . . Co_?_a70(o2 THE NEW YORK BOAR® OF FJR"E UNDERWRITERS PAGE ' 1135115 BUREAU OF ELECTRICI7Y� - F 40 FULTON STREET, NEW YORK',,NY"10038', Date FEBRUARY 22,2000 Application No. on file 10087"100/00, N 515999 THIS CERTIFIES THAT PERMIT NO. 26204 , only the electrical equipment as described below and introduced by the applicant named on',the a'bo'veapplicationnumber is in the premises of FRANK ASARO, 25A 'RING KULLEN SHOPPING CTR, CUTCHOGUE� PIS' , _ in the following location; ❑ Basement © lst Fl. ❑ 2nd Fl. Section 097 Block0005 Lot 012 was examined on FEBRUARY 16,2000 and found to be in comphan,"with the National Electrical Code., FIXTURE RECEPTACI S, SWITCHES "' ' FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUSTFANS OUTLETS INCANDESC T FLUORESCENT OTHER AMi K.W. AMT. - K.W. AMT, K.W. AMT. K.W. AMT. H.P. 36 14 19 15 21 4 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS. "BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL H.P. GAS N.P. AMT N SYSTEMS J)" A.W.G. AMT. AMP. "AMi." AMPS. TRANS. AMT: H.P. NO.OF FEET AMT. WATTS 3 SERVICE DISCONNECT NO.OF S - E R '- V - ,I C E METER ry0,OF CC COND A.W.G. A.W.G A.W.G. AMT. AMP. TYPE E6TUIP. I 0 RW 1 0 3W 3 0 SW 9 0 4W pER 0 Of CC.CON,, " NO.OF HI-LEG OF Lo A. NO.OF NEUTRALS OF NEUTRAL OTHER APPARATUS: 80014 FOOD WARMERS "HATCO"-2 COMMERCIAL DISH WASHER-1 30A DISCONNECT DOUGH MIXER-1 EXIT LIGHTS-3 EMERGENCY BATTERY PACKS-4 PANELSOARDSt1--10 CIR. 100 atm L L EASTMANOR ELECTRIC INC LIC.#3691 GENERAL MANAGER PO BOX 192 4, MANORVILLE, NY, 11949 Per This certificate must not be altered In any manner; return to the office of the Board If incorrect. Inspector's may be loatified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE` ALTERED IN ANY MANNER. ACTION SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES (/U1. PAGE CONT Ll CHGE 0 FOOD ESTABLISHMENT INSPECTION REPORT OF MW El DELT , NUhffiER.D. SIA. EISA EME• ' f , . ADESTAB,DRESS ' s COMS: A �. DAY �T AC TY NAMES I/ CNAME PHONE ik CORP. (�, ZIP t �{ WATER SE4RCz FImZEN ADDRESS CODE t .! SUPPLY DIST. DESSERT ACTIVITY Ne3�5. CERT. INSPECTION TIME OF -P WATER SAMPLE DAY YRr „d CODE ' NUMBER I DATE INSP. . DATE / ,` �t CHOKING SIGN YES NO511�ECONOMIC YES NO S.A.F.E. 1r � 2 - 3 REINSPECTION POSTED VIOLATION CIACSIFICATION \::''�cJJ lE S PART 1: RED CRITICAL ITEMS ,/ SUMMARY OF ITEM C VIOLATIONS NO. ITEM DESCRIPTION OF VIOLATION DATE NO. THESE ITEMS RELATE DIRBMY TO FACTORS WHICH LEAD TO FCbD130 ILLNESS AND ST RECEIVE IMMEDIATE ATTENTION CORRECTED TA u)ecElol ' r �Or rCrn. t� Im�fe y s �t 4, go J14 PART 2: BLUENTENANCE I SUMMARY OF ITEM VIOLATIONS 140. ITEM - DESCRIPTION OF VIOLATION CORRECT NO. THESE ITE+fi RELATE TO MAINTENANCE OF THE FOOD SERVICE OPERATION AND CLEANLI SS. CORRELT AS SCHEDULED. BY r' a o Pdil ✓ E i kIQQ { U VVI 31 �u4 i u 2 farim o mcO m�k , r. � IK�i r -lor eh�-r r , f THE MARKED ITEMS ABOVE ARE OL4TION FO DUR NG INSPECTION F THE OPERATION OF FACILITIES IN THIS ESTABLISHMENT WHICH MUST BE CORRECTED A$i ICATED. FAIL TO COMPLY MAY RESULT IN THE INITIATION OF LEGAL ACTTON AGAINST THIS ESTABLISHMENT AS PRO ED' R IN C& 2 13 OF THE SUFFOLK COUNTY SANITARY CODE INCLUDING A HEARING, POSSIBLE SUSPENSION OF OP RATION, OR P ICATION OF THE VIOLATI N AND FINES. SIGNATURE OF PERS ITLE 'SANE LI h 4 INSPE ON RECEIVING REPO �. �� - S S ----- - ----- RED CRITICAL ITEMS - MUST RECEIVE IMMEE)LATE ATrENPICN ITEM FOOD SUPPLY- FOOD NOT ADULTERATED ANTI RECEIVED FROM APPROVED SOURCE ITEM CONT. FWD PROTECTION - COOLING/REFRIGERATION AND HOT STORAGE 1. ..FOODS INCLUDING SHELLFISH, WHOLESOME UNADULTERATED AND FROM AN APPROVED SOURCE - 14 .POTENTIALLY HAIARDOUS FOODS An MAINTAINED AT OR BELOW 42 DEGREES FA14RESHEIT OR ABOVE PASTEURIZED MILK AND MILK PRODUCTS USED, 140 DEGREES 2 ,.CRACKED EGGS, PASTEURIZED - LIQUID FROZEN OR POWDERED EGGS USED. 15 . INGREDIENTS USED TO MAKE POTENTIALLY HAZARDOUS SALADS ARE PRECHILLED BEFORE MIXING 3... FWD CONTAINER SIR)WING EVIDENCE OF SWELLING, RUST, LEAK OR OTHERWISE IN SUCH 16,. SUFFICIENT NUMBER OF REFRIGERAITORS AND 1407 FWD STORAGE FACILITIES AVAILABLE FOR THE CONDITION AS MAY RENDER THE PRODUCT UNWHOLESOME NOT BEING USED. STORAGE, DISPLAY AND TRANSPORTPTION OF POTENTIALLY HAZARDOUS FOODS AT NEW IRED 4.. .MO USE OF MME PREPARED FOODS TEMPERATURES ( µ2 DEGREES 0 1140 DEGREES ) 5....WATER/ICE FOR HUMAN CONSUMPTION FROM APPROVED SOURCE PROTECTED FROM CONTAMINATION AND 17. .UNWRAPPED/POTENTIALLY HAZANDOUIS FOODS NOT RE-SERVED CROSS-CONNECTION 18 COOKED OR PREPARED FOODS PROTECTED FROM CROSS-CONTAMINATION FROM RAW FOODS 6.. .SHUCKED SHELLFISH STORED IN ORIGINAL CONTAINER AND PROPERLY LABELED. OTHER FOODS 19 .READY-TO-EAT POTENTIALLY HAZARDOUS FOODS PREPARED USING CLEAN SANITIZED UTEN51LS AND PROPERLY LABELED EQUIPMENT 7....SHELLFISH STOCK PROPERLY LABELED - TAGS ON FILE FOR 60 DAYS. N) FWD PROTECTED FROM OVERHEAD SWAGE LINE DRIPPAGE OR OTHER SOURCE OF POSSIBLE HASTE WATER CONTAMINATION. FWD PROTECTION - COOKING AND REHEATING 21.. TOXIC CHEMICALS, LAWFULLY PERMITTED, AS ARE REWIRED TO MAINTAIN SANITARY CONDITIONS, ARE PROPERLY STORED, LABELED AD USED. 0. ..PRE-COOKED REFRIGERATED POTENTIALLY HAZARDOUS FOODS, THAT ARE TO BE REHEATED ARE 22 PERSONAL MEDICATIONS PROPERLY TORED SEPARATE FROM FWD, PREPARATION AND SERVICE HEATED RAPIDLY TO AREAS 165 DEGREES FAHRENHEIT OR ABOVE. 23. FWD CONTACT SURFACES OF UTENSILS AND EQUIPMENT MADE OF NON-TOXIC, CORROSIVE 9....STUFFINGS, STUFFED MEAT AND POULTRY COOKED TO 165 DEGREES FAHRENHEIT. PORK AND PORK RESISTANT MATERIALS. PRODUCTS COCKED TO 150 DEGREES FAHRENHEIT. ROAST BEEF COOKED TO 130 DEGREES 24...FOOD PROCESSING AND PUBLIC AREIS FREE FROM SEWAGE, FAHRENHEIT. ALL OTHER POTENTIALLY HAZARDOUS FOODS COOKED TO 140 DEGREES FAHRENHEIT. 10...FROZEN FOODS LARGER THAN THREE POUNDS NOT DEFROSTED AS PART OF CWKIM PROCESS, FOOD PROTECTION - EMPLOYEES FOOD PROTECTION - COOLING/flEFR ICE MTIOH AND HOT STORAGE 25.. FOOD WORKERS USING PROPER UTENSILS DURING PREPARATION OR SERVING OF FOOD TO MINIMIZE HAND CONTACT (TONGS, SPOONS, SI+ATULAS, PLASTIC THROW-AWAY GLOVES) 11...SMOZED FISH MAINTAINED AT 38 DEGREES FAHRENHEIT. SHELLFISH STORED AT TEMPERATURE TO 26 EMPLOYEES ENGAGED IN FWD PREPARATION OR UTENSIL HANDLING, FREE FROM ILLNESS SUPPORT LIFE TRANSMITTABLE THROUGH FWD, WAITER OR EQUIPMENT ( HEPATITIS, DIARRHEA, STOMACH FLU, 12...SOLID OR SEMI-SOLID POTENTIALLY HAZARDOUS FOODS SUCH AS GRAVIES AND PROTEIN TYPE INFECTED CUTS OR ACUTE RESPIRATORY INFECTION ) . SALADS, ETC STORED IN SHALLOW PANS WITH A FWD DEPTH OF LESS THAN 4'. 27. ,FWD WORKERS AFTER HAVING HANDED RAW FOODS, COUGHING, SMOKING, SNEEZING OR OTHERWISE 13.. POTENTIALLY HAZARDOUS FOODS COOLED BY AN APPROVED METHOD WHERE PRODUCT TEMPERATURES HAVING CONTAMINATED THEIR MAN S, WASHED THEIR HANDS THOROUGHLY BEFORE RESUMING WORK. CAN BE REDUCED FROM 120 DEGREES FAHRENHEIT TO 10 DEGREES FAHRENHEIT OR LESS IN TWO ------- ---- ---- ---- HOURS AND 42 DEGREES FAHRENHEIT OR LESS WITHIN SIX HOURS, THE PED CRITICAL ITEM NUMBERS NOTED ABOVE RELATE DIRECTLY TO FACTORS WHICH LEAD TO FWWORNE ILLNESS AND MUST RECEIVE f MMED1ATF ATTENTION GLUE MAIN ENAM"E ITEMS - CORRECT AS SCIMLU ED ITEM GENERAL REM IREMENTS ITEM CONT. CLEANING WASHING AND SANITIZING OF EQUIPMENT AND UTENSILS 28...VALID FOOD ESTABLISHMENT PERMIT PROMINENTLY DISPLAYED. W...FWD CONTACT SURFACES WASHED, RINSED AND SANITIZED AFTER EACH USE AND FOLLOWING ANY 29...VALID F000 MANAGERS CERTIFICATE DISPLAYED. TIME Of OPERATIONS WHEN CONTAMINATION MAY HAVE OCCURRED. - 30...SMOKING/LAW COMPLIED WITH. 50...NON FWD CONTACT SURFACES OF F?UIPMENT CLEAN. FOOD PROTECTION GENERAL SANITARY CONTROL FACILITIES I' 31...FWD PROTECTED WRING STORAGE, PREPARATION, DISPLAY, TRANSPORTATION AND SERVICE FROM 51...ADEQUATE AMOUNT OF NOT AND COLA RUNNING WATER UNDER ADEQUATE PRESSURE PROVIDED NOT POTENTIAL WATER TEMPERATURE TO BE MAINTA Y NED AT A MINIMUM TEMPERATURE OF 14D DEGREES SOURCES OF CONTAMINATION (FWD PROPERLY COVERED, PROPERLY LABELED, NOT STORED FAHRENHEIT. DIRECTLY ON FLOOR 52. .ALL SEWAGE AND LIQUID WASTE BEING DISPOSED Of IN AN APPROVED SUBSURFACE SYSTEM. PROTECTED WITH ADEQUATE SNEEZE GUARD, FWD CONTAINERS NOT DOUBLE STACKED). PUBLIC SEWAGE SYSTEM USED IF AVAILABLE. 32...IN USE FOOD DISPENSING UTENSILS PROPERLY STORED. (•CE CREAM SCOOPS STORED IN RUNNING '53...PLUMBING AND SINKS PROPERLY SI{ED, INSTALLED AND MAINTAINED. EW IPMENT AND FLOORS WATER), PROPERLY DRAINED. I 33 . CLEAN AND SANITIZED UTENSILS AND EQUIPMENT PROPERLY STORED. 54...ADEQUATE, CONVENIENTLY LOCATED(TOI LET FACILITIES PROVIDED. FACILITIES CLEAN AND IN 34...SINGLE SERVICE ITEMS PROPERLY STORED, DISPENSED AND NOT REUSED. GOOD REPAIR. 35. .ACCURATE THERMOMETERS AVAILABLE AND USED FOR THE EVALUATION OF COOKING REHEATING AND 55...HAND WASHING FACILITIES PROVIDIED WHERE REQUIRED, PROPERLY MAINTAINED AND SUPPLIED NOT OR COLD STORAGE TEMPERATURES. (BAYONETE THERMOMETER AVAILABLE) WITH SANITARY TOWELS OR HAND DRYING DEVICE AND HAND CLEANSER. HAND WASHING SIGN 36...PIGPEN THAWING PROCEDURES USED. (UNDER REFRIGERATION OR COLD RUNNING WATER). POSTED, j 37...RAW READY TO EAT FOODS PROPERLY WASHED BEFORE SERVING. (FRUIT,VEGETABLES). GARBAGE AND REFUSE DISPOSAL PERSONAL HYGIENE AND ACTIVITIES OF I"WORKERS 1 56...ADEQUATE, LEAKPRWF, NON-ASSORIANT, VERMIN-PROOF, COVERED CONTAINERS PROVIDED WHERE 38...PERSONAL CLEANLINESS ADEQUATE, CLEAN DOTER GARMENTS WORN, NO EXCESSIVE JEWELRY WHEN, NEEDED 39...SMOKING,USE OF TOBACCO, EATING OR DRINKING PROHIBITED IN FWD PREPARATION, 57...GARBAGE STORAGE AREAS PROPERLY CONSTRUCETD AREA MAINTAINED CLEAN. DISHWASHING AND FWD STORAGE AREAS, 40. .PROPER HAIR RESTRAINTS USED. INSECT AND RODENT CONTROL 41...ADEQUATE DRESSSING ROOMS PROVIDED, FACILITIES KEPT CLEAN, PERSONAL ARTICLES PROPERLY STORED. 5G...PREMISES MAINTAINED FREE FROM RODENTS AND INSECTS EFFECTIVE MEASURES TAKEN AGAINST THE ENTRANCE OF INSECTS AND R06ENTS INTO THE PREMISES. SANITARY DESIGN, CONSTRUCTION AND INSTALLATION OF EQUIPMENT AND UTENSILS 59...PESTICIDES APPLIED UNDER THE DIIRECT SUPERVISION BY A CERTIFIED APPLICATOR IN ACCORDANCE WITH LABEL DIRECTIONS AND IN ACCORDANCE WITH APPLICABLE LAWS. 42...FOOD(ICE) CONTACT SURFACES OF EQUIPMENT AND UTENSILS ARE PROPERLY DESIGNED AND I CONSTRUCTED, FREE OF CONSTRUCTION AND MAINTENANCE OE PHYSICAL FACILITIES CRACKS, DENTS, RUST, OPEN SEAMS OR OTHERWISE NOT EASILY CLEANABLE. 43. .MON-FWD CONTACT SURFACES Of ECAIPNENT AND UTENSILS ARE PROPERLY(RESIGNED AND 60...FLOORS, WALES ANO CEILINGS PROdERLY CONSTUCTED, SMOOTH AND EASILY CLEANABLE AND CONSTRUCTED, INSTALLED SO AS TO BE EASILY CLEANABLE. MAINTAINED CLEAN 61...ADEQUATE LIGHTING PROVIDED IN FWD PROCESSING, STORAGE AND UTENSIL WASHING AREAS. CLEANING WASHING AND SANITIZING OF EQUIPMENT AND UTENSILS FIXTURES PROPERLY SHIELDED 62...ADEQUATE VENTILATION PROVIDED (STOVES PROPERLY NODDED AND VENTED TO THE OUTSIDE. 44...WASH AND RINSE WATER CLEAN AND AT PROPER TEMPERATURE HOODS, DUCTS, FANS AND FILTERS'IMAINTAINED CLEAN 45 .SANITIZING RINSE AT PROPER TEMPERATURE.CHEMICAL CONCENTRATION AND FOR APPROPRIATE 63...PREMISES FREE FROM LITTER ARTICLES NOT PERTAINING TO THE OPERATION STORED AWAY FROM TIME, PREMISE. ALL OTHER ARTICLES PIOPERLY STORED 50 AS NOT TO CREATE A NUISANCE, 46...PROPER WASHING TECHNIQUE USED.(WASH,RINSE,SANITIZE). 64 ,.LIVING QUARTERS COMPLETELY SEP IRATE FROM FWD ESTABLISHMENT OPERATIONS. 47 .ACCURATE THERMOMETERS, CHEMICAL TEST KITS AND PRESSURE GUAGES AVAILABLE TO MONITOR 65, .LIVE ANIMALS, BIRDS qN0 PEAS. JXCEPT SPECIAL ASSISTANCE DOGS RESTRICTED FROM PREMISE DISHWASHING AND SANITIZING OPERATIONS M..,CLEANING EQUIPMENT AND LINENS NROPERLY STORED, LAUNDRY AREAS SEPARATE FROM FWD 48...WIPING CLOTHS CLEAN STORED IN A SANITIZING SOLUTION BETWEEN USE PREPARATION AND STORAGE AREAS.( 18490..9/91 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CERTIFICATE OF APPROVAL OF FOOD SERVICE ESTABLISHMENT FOR CONSTRUCTION, ALTERATION OR REMODELING Applicant Establishment Location Michelangelo's 31455 Main Road Cutchogue Approval is issued under the provisions of Article 13, Section 1304 of the Suffolk County Sanitary Code for: 1) New Structure 3) Conversion 2) Remodeling 4) Other THE FOLLOWING CONDITIONS APPLY: 1)THAT THE PROPOSED CONSTRUCTION BE INCONFORMITY WITH THE PLANS AND SPECIFICATIONS APPROVED BY THIS DEPARTMENT. 2) THAT THE APPLICANT CONTACT THE APPROPRIATE DISTRICT OFFICE OF THE FOOD CONTROL UNIT PRIOR TO OPERATION OF THE ESTABLISHMENT TO ARRANGE AN INSPECTIONOFCOMPLETEDCONSTRUCTION.THIS CERTIFICATE IS NOT A PERMIT TO OPERATE A FOOD SERVICE ESTABLISHMENT. OPERATION WITHOUT A SATISFACTORY PRE-OPERATIONAL INSPECTION AND/ORA PERMIT TO OPERATE WILL RESULT IN LEGAL ACTION. 3) THAT THE APPLICANT SHALL ASSURE CONFORMANCE WITH THE FOLLOWING AMENDMENTS TO PLANS AND SPECIFICATIONS: • A copy of"Certificate of Authority"to collect sales tax must be submitted within 30 days of issuance of permit. ISSUED FOR THE COMMISSIONER OF HEALTH DESIGNATED REPRESENTATIVE DATE RAINING AND PLAN REVIEW UNIT*NORTH COUNTY COMPLEX BLDG#159 VETERANS HWY HAUPPAUGE NY 11788-0099 *631-853-6973 T 3 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ 1--T'FINAL����� ,..� [ ] FIREPLACE & CHIMNEY fill REMARKS: V DATE� INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ j FOUNDATION IST ( ] ROUGH PLBG. [ ) FOUNDATION 2ND [ j SOLATION [ ] FRAMING ( ) FINAL [ ] FIREPLACE & CHIMNEY REMARKS: 5 DATE INSPECTOR 765-1802 BUILDING DEPT. NSPECTIO [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: ��-- 1L�.r.�= t DATE (�1121/ 24 INSPECTOR F'i I H�11 IE Ilii, 1 1 FFUM -I t P.1, vv Y""i Tv z IN c M- A"AX 85 Aq DOUQUE1 LACE 8 5 411 8566 Q(JADF_&E)OT pLoj�,kL SPRAY 45"FRINCH LAC F rr y I Vw 8961 WATER M 8545 STARGAV� $446 COPERNIC';' 68 puln F-OSE LACY, $i r Nr MeMdue. c =mer0iol Pc mau _z6,6 Fiber Itype! F k 13 R I r N 1, 1 N(s ap Dy(' P_eoola Ileat sot \fllil-ari gtm)LIV i;,M Aiit�z eahaOnC FABRIC iFtni24 oz.i Yd. sh,�d Vacc we,�gl�tt ply 110 ga (2 70 gi i tutu 5i;, inchIT Airlki V%, ti secondary Bdckine- 52 oz.,: row wr-4= —pEPFORM .dLNCT, SPECIFIC A.i `T ! ON Densivy: 3,OK V (AAf CC-7, CM ' �', 't �34" I 'r-I". T-affir, Radiant Nnal: > 45 wa"s �cm-,q, ;ASTM.- E6,48 Cies 1) <,i5o Flaming& wnflamin,(ASTAII-E662 N14'A-2568') NIBS smoke cl-ambor SpeC,,,pICArjO\jTS SLTB,JFCT TONORYvLA!, ICi IFACTUI INTOLERAN CES AND MAY BE C14A.NQBD)�qTHOIJT PRIORNOTIC7, I Z) ACCrPITANCE OF OTkDERS SUBJECT TONIULUXS-IN'S :.'C)NIDITIONS OF SAL P, BOARD OF HEALTH . . . . . . . . . . . . . . . FORM N0. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . „ SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: / GG CALL �j /y�c� MAIL TO: . . . . . . . . . . . . . . . . . . . . Approved... ....:. .... 19./'7 Permit' No. ................ ..... Disapproveda/c .................................. ..................................................... Z 5� ' (Building.90-re APPLICATION FOR BUILDING PERMIT NOV p Date. .//. ./. . . . . . . . . . 19� /. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wit 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 mist be drawn on the diagram which is part of this application. c. The murk covered by this application may not be camenced 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 104W MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zane Ordinance of the Tam 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 i buildin or necessary inspections. I` (Signa a licant, or name, if a corporation) PVl T cMEI,6 W A 4-NFy--ntM&A .5. ... a4kS N ..AA:t.!�J.: (Mailing address of applicant) NJ VM-1301 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................................................................. Nam of owner of premises .... 54.9:()-rA......................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. ............... g•pe. .. Plumbers License No. ................ el��m� Electricians License No. ..............!^:;'.er. Other Trade's License No. .................... 1. Location of land on which proposed work will be done.............................................................. T. ? Cs�C0 G V'E ......... .+:��.�...........FZ . .. ...............................................Hamlet.................. -Mwhse Number Street County Tax Map No. 1000 Section .....�.7...... Block .....5......... Int ......... Subdivision ...................................... Filed Map No. ............... int ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...P.I:? .k1, ,.... .., .5`f2�U Ae�1T.............................. pl ......... ���n-Ani-r.. .......................... b. Intended use and occupancy Z ............... 1 3. Nature of work (check which applicable)- New Building .......... Audition ........,. Alteration ..X.... . . Repair ............ Rghhoval ............. demolition ..........,. Other Work ......,...........,... ....s......... (Description) Q' Estimated Cost 1� 0 0 0. .. ..a.,........:1........ fee ............................. ........... . .. . I (to be paid on filing this application) 5 . If rkaelling, rud er of dwelling units ............ limber of chaelling units on each floor ... . .. .. . . ... ... If garage, rxmter of cars ..... ..........I.............I....... O/ZZ,o/z,rA 40 IZESlYi✓RA^(T Ifbusbusiness, �`stirh ialaomixed occupancy, specify nature and extent of each type of use....... , 2oP 0 Sf,•• , • ions ng es, if any: Front.....�-Y4:�... Rear ............... Depth Ileiglht .................... ..a timber of Stories ....�................ Dimensions of sauce structure wish alterations or additions: Front ....��4..�... Rear .. .......... ... Depth r Q...... tie i t .................... timber of Stories ....../., . r r / 4+ . Dimensions ofentirenew constr Ction: Front .....r�.... .,. Rear .... ........... Dept: .t? ......... IIe ................ Umberof Stories ..�.../^!!l Gk -ink, (Ze7 j2/GEa�,c7b2 q f"dtl , c Size of lot: Front ..A&R)'r 304,:... Rear ..... /. .8. .\�D�@�th ..f0..�..'. 10, Date of Purchase wlf.rr of onmr O.�rmr '1'rcYt.. r1Cdo VT 'Lo Y/ts� 11. Zone or use district in which premises are situated ...................... ......................... ............. . . 12. Ekes proposed construction violate any zoning law, ordinance or regulation: ... 13. Will lot be regraded .....NI......... Will excess fill be rarov fTam anises: YES Q NA iJ„sEo??� t Z� s�nrs�y (158 -(26e SIG-SGI-9soo W. Names of Owner of premises N){]reas .Yft.. �!.�71?�?..,.,,.Y ..... Pune No. -5 . s'0 Nana of Architect 44 -A1!F6131, .„ Address 5.7 9!!!a?DO.AK.:• Wi AYVIIA,9E , N -y I1�g6wlbol. : ........... Name of Contractor ........ ... Address ...................... ....More No. ......... . ... IC YE-9, tyw idD T300 feet of a tidal wetland? * YES .......... ND .�..... I5. Is Uhrs properly within 300 fee ilms Pmrr MAY BE EI yrm. PLOT DIAGRAM locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions Cram property lines. Give street and block nuuber or description' according to deed, and show street nares and Indicate Ahether interior or corner lot. 5 ATTA c4 -p 5 J-�Y SrNIR f%' NI-M YCAT, auNlY or v� , ......... SS', •M ...being duly sworn, deposes and says that the is Lha applicant (Name of individual signing contract), above nmed, Ile is Lhe ..... ... ........ ................................................................... (Contractor, agent, corporate officer, etc.) /q/Z Cy/TE CT of; said owner or wrxers, and is duly authorized to perform or have performed the said work and to make and file Uhis application; that ail statements contained in this application are the to the best of his krxrwledge and belief; nix] Lhat the work will be performed in tho manner set, forth in Ube appl.ica�ion filer? Lherewidh. Sworn to before me this q 4 ffay of c9 4!�7V1 ...19 ..... Notary Public .. .. .. ...........i ............. No1arY PuUlie;,br; ....... ............................ (Si , tune f pplicant) L.E E rREu'fClY� �re of New York No, 1#"f!jtolk rl pDD� Qualified mh li'y�ftolk CournG/.Q” Cohnnussion Expires July 31,n y >3 `b SEE 1[C M40BJ � LINE aK�-.-----�aTcx ull[ �_ eN�__yL u_._[ • I♦ cart« --�— NE _. .•23upo ti'! eRio • rs RM MIEC41q. _ '•� t• • ' fM MISSL «n hlrg • ¢[a6.ND m-02-°IOI At l e\�„ + PM me.W . rM ac A «D. / S SEE SEC.«6pB5 Sf[Sf'.«-,012 SE[ SEG MS MS 2>♦ i + te•t •Oa-OOe ; -oa-D12 -03-0102 I +T i S, .`M1• • � 'M1'• t' LT BPI =_: - c N� y to �• O A, la ♦ V s 42.u14) •E�1 A' t,O' A•• Wal.) _ L .w� i � to •A • � E O e I • tB ,•• • •i 11 n t!f♦ 3 ''10 Ib�Mei tT M1♦` P • as ♦\< 2 � aur � ! �Ir B b zT oilA. V 2 1 p? s JILMA AA '' `� taBlcl •__ ` '� z ♦ L^:]ST K28 -$;e; -;¢: .w TL .moi, - GA 3fAa1[) < yll� • �`.„ t 2J - 16 0 nl\ 'e '9v , 4 • r +e 2.BA(c1 le•1 N:.01(c) _ fNlc 3 \Z a ,M1 g +'A/ , N 4 a ♦ 2 �4 a e.•• s ` . •�. "♦ •^ e' +e/ _ wSuo' ':_ 9L"• ID />04 ' _ • A° 'gam .o°0w •./ 12.5a1<) T.Ialc) ,o" 1 /• M1g` • t M1 - / \ •2`TJ/ '. • '••• ISilc) 114(c) Iff.J IBQ 'mu _ „ ^\ .++ w •\ ,- r y M1' � O w N ti ' .+e/ ^ j= ' e f +.' a.I A ��� '` u Y '`R :�„ _ l? 3 J�•` r•. : e« ./e, a S:O: 2741(.) / r I, } z It G e if D e 2 6 `4/ n♦�' 9q'P °a++4 O 3 � E �, � yB 2B.a of+ �• '23 r• a,a� h •a'� Y „! hF. a `^ e S ' �/ .•' � • 5 0 ilf T 2B•5 g en.•'M _ , - � y t .. 4 - SEE 4_ ` •e'I • � n•' , S 5 � •w �e•m�_ --_ '�•+>Ft n •/D Via.• 6 6 \c � J � 'L.' T. LND S _ / _ 'm � i 8 0 1>; .t 2\+•+3 *26•B a •f �� h�a ,•B • A* •Ti' E ANTLER 0 L,`. taw• » .�IL:a •c•T _ 3 i wa...= .,`T e'. 0 e v : .2C•,Y T sa O • ?/+/ FOR PARCEL«D. e•� t.e..'11Lt6 $ . .+f - Md „ ...zz a ��n9,i u_v�/v , .w • ~\?"'' h. • ''�#' z'O - .L c:,2 e. 2 _ Z ` • b,,.T a`..-. ,a OR. N`= SEE 5P1«0.10) 1' ,• . a •. _ eo_o p_-°x019.1 i• Y7 O yff �•' g .r 1T> Y » 19• 12MB ��`S3 p• y'�j ,\> ^�V 8 YITOIL Z LINE A f MATCH LINE. •E f.ll a :13OV_ _ .T TCx� UAE _ ..IST- ue[ »LJPt'N a • ••c= - YATC� SEE SEC.x0.103 a t— .... ,a. w, a .3 I. St__—. ,o .. wS„•u.cf. .e. •n„P•`+y[ ll o AT. • .n ., die : __ :a.P3f' ...� 3�« : 353 M..e.•e•[ Ct � - Legend (iii RET P »"e 3' M © COUNTY OF SUFFOLK T°^°F SOUTHOLD Ri4k Yl -T 31rEP. JR INa.....D.+•.o L•^•__x.__ L„w. M wTr,E rEP P"^^E,....p..• i»..L••+ ____ .„..p.„rv.�L.» __.,__. qh„,D�»ar t•n._ R.__ p.r p..»u« qY I 6 amt tW 4m Real Property Tax Service Agency VILL16EOF Q/!� C....Ir»,f•,.r•. --L--L— _ _ VAIae.L•n. L•p4•P,rv.a L••+ _.L SCALE w FEET y �M1JJ..11 R•.L,a„r,Pmn+,l.enie q,.l„r !r BI•h L•.n P.i Dnn.n L.0 P.qI Ne. 2J D,t Ne Ilq«I J CODn)Y �enler DISTRICT«0. IOOO 1 br•.. ��kMl F+nn Lw __YX_- .•Dnuar Lw __,S__- J.M.n r.B�»t xr RD G.i..l„•..e.. Tbld j tOj ' Rworhe°d, L. 1., New Yor4 n W. Y• , i - BUILDING PERMIT REVIEW CHECK LIST Applicant/ _ C Date Owners Name: N oLQ ,+ '`�1 ` J_e�6+0. Reviewed: Architect/ ( r Date Engineer: NV �-eA-e-P_ VU1! Yr ,,+ `vim L Submitted: SCTM#: District: 1.000 Section: �� Block: Lot: Project 4 Subdivision � ,, f, Location: �� \&a (N 42W' Name: Single&separate Required certification: Yes/14 0 3 Req. Req. Zoning District: [Lot size: Actual: ] [Lot coverage Proposed: 1 Req. Req. Req. [Front Yard Proposed: [Side Yard Proposed: 1 [Rear Yard Proposed: Project Description: AGENCY PERMITS Permit REZUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? Flood Zone: to • HARDY PLUMBING, HEATING & AIR CONDITIONING, INC. `j2eu.��Cuvsticuustitayv�w.rsiav 1654 County Rd 39 Tel: (516) 283-9333 Southampton, NY 11968 Fax: (516) 204-1128 March 1, 2000 To Whom It May Concern: 1 Please be advised that all gas piping done at Michael Angelo's Pizza Main Raid Cutchogue has been mercury tested at 8-inch water column for 2 hours:_. All sprinkler leads relocated were done to code and have been pressure tested. very truly yours, Hardy Plumbing, Heating and Air Conditioning, Inc. Rick���� e��Pttoc� cw�ar 1 -1t\Y� aNp tb1W tao 61 a01a0 15 WD C (� 1C� ��'_ y (NSP 1111N tt�'•�'VK, II 1f1`• II _____- II II L7 n-- --- DATION ( IST) it n it \ (DATION (2ND) t I it II it :H FRAME PLUMING ------ 1 II -------- — — — it II _ N 1 I j JLATION PER N. Y. II H 1 II iTATE ENERGY CODEit u ii u u I II I II I!I FINAL Theu New York Board of Fire ADDITIONAL J Underwriters - ,'l/T ,pypyOar+c is in the process of issuing a certificate of compliance for the electrical installation Gf/h as covered in an application noted .� below. The certificate will provid det�ioof the items inspected on _2���' and certified to be in com'plla ace with the H National Electrical Code as of that date. �J 7 ©0 I H I — (Application Number) )fit 25�� � ,• ��� - - --, ( tion) ------------- ----- --------------------! - (Inspectop BD(Rev. 01/96) Y M-1602 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: �. C Js `��� DATE_` /6 /0�0_INSPECTOR i s 346.98 •� N4TO6'2OE � ' OW Co�c. 'Mn/i. W .r e � • Ol e O . e !N 4! Pl. _ _ p v 11 1 � �(� pp w1LT - 4 � PRo Pe`x`D , �Fr�C> K�LLa7.r` U B41/1-0/N6 A•:- - v �'14� X5, Y t* - III 4•r-'.'r t s y r " 'r ." _ I ., d'4.rr tt. - Ow cw er- a I ' - �yF AEy " a OW. Ot� - pwa enr. Z � _ I - � _ I P.1. — - I Co✓0. - .. '0I •3 � I K, t H. ` � I O tile- � • , • f� * ,�.t � SIG. '- GYLI - N✓G.� .: __ _ � • ��y� p ?64.04 m en✓c!_--w.�. .✓i. w�w�. - - e.Ne w. b /300'70 CONY L.AAI/-- � o N c e Et ./11i'aira Road . . v Ru'y F`iI,t.;f2! [y�.>, ' J/•7/uO fCU _� /l/ YYIWFj NL'MNw IYrFSaI Asa Mir A2r s - I� CU /'TC W I tlJ usVwa W r rp:zi uwn G .w s v� [ �I ..r ci- r �.�4.3?si °o 70a/ Of SO uthO/d, _SezllolX Co.,N.Y AIAr a w a�QOTa ',: 'r./COR T/TLE G({ARANTEE CO. - Omm'� a 1'c� x- - - 1 I �^ ° fFY 516,its "„• zs i— G li. csh ; e— n'cirY:Inur¢s,n+N'sem[ �.acs.dslw,.vu nr.;, _I K— ! pfL ! 919/ �1 —Fn, _ �- FP✓�wo• Lae./1/!.r L./sv1 B.fe..