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Home My WebLink About49353-Z r 81 TOWN OF SOUTHOLD " BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 49353 Date: 6/9/2023 Permission is hereby granted to: Homan, James PO BOX 738 Cutcho ue, NY 11935 To: construct alterations to existing retail business as applied for per Suffolk County Health Services approval. At premises located at: 31000 Route 25, Cutcho ue SCTM #473889 Sec/Block/Lot# 103.-1-1 Pursuant to application dated 5/9/2023 and approved by the Building Inspector. To expire on 12/8/2024. Fees: NEW COMMERCIAL, ALTERATION OR ADDITIONS $250.00 CO-COMMERCIAL $50.00 Total: $300.00 Building Inspector rr TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 y Telephone (631) 765-1802 Fax (631) 765-9502 h�gg //ww,w ouutholdtownny- oy' 0 . Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only �j PERMIT NO. " Building Insp cton--k-- �-J Applications and forms must be filled out in their entirety.incomplete applications will not be accepted. Where the Applicaritis not the owner,an Owners Authorization form(Page 2)shall be completed. Date: - 2, OWNER(S)11 OF PROPERTY: Name: myvy'mi ILIOAViA) SCTM # 1000- �� y ri J�j Project Address: 3ioco r,��1 P-) Phone#: &, �(' 73-( - 6 700 ,� 3 Email: ' � C� yi�'��N��r�, j✓oav . eom Mailing Address: (a0 G3�K 7 k yo � / A,)- 1 CU TC a C,✓G' CONTACTPERSON: Name: Ke & nncj Mailing Address: ( >.e &,,, cjAb6UJ�- f S1-1 l(' �S Phone#: i � �,(_��c + Email: t�z,1�-�i !�-p✓u�Stj/ .x� DESIGN PROFESSIONAL INFORMATION: Name: ° r" Mailing Address: lvxt�JA C(, Phone#: (,� <3 6 (.,-, Email: CONTRACTOR INFORMATION:,` Name: � Mailing Address: Phone#: �- ��(�> Gl Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑No 1 PROPERTY INFORMATION Existing use of property;. Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes []No IF YES, PROVIDE A COPY. ❑ Check Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. 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,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 building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name): L ��, J, ��\Ly,. ❑Authorized Agent CEfOwner Signature of Applicant: , �"� ., ��"" +""� ° Date: e_-o STATE OF NEW YORKK�)///, COUNTY OF SLC- `'s being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the C ` (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly 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/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this fin} day of ,20� o„ gate ol New 101% , 021.03 Qualified in 30101k Caunty !.�p Commission Expires June 20,20 PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) I, cSj - residing at ( do hereby authorize �” to apply on my behalf to the Town of Southold Building De artment for approval as described herein. 1 bCI*N Owis Signature Date Print Owner's Name 2 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES PLAN REVIEW UNIT FOOD ESTABLISHMENT PLAN REVIEW APPLICATION Phone No. 1.Name of Establishment: -- — 2. Address of Establishment: Zip Code _� ,ITc �, =' .. ,mm�h _....-...�.- Street � Town �-'- , ..Phone No. 3.Name of O erator, r . � t Op r w......... 4. Address of Operator- ,�� ..._�. Gr �.... (V.. ` Town-, ,��, �,,..��...Y�._..�.... � ... "_. ...... p StreetZip Code 5.Architect, Engineer or Food Consultant: Phone No.mm Street: Town: Zip Code: 6. Email address of lan review contact: 7.Type of Operation (check all that apply): ❑Restaurant(with seating) ❑Restaurant(without seating) ❑Delicatessen ❑Tavern []:Bakery ❑Off Premise Caterer ❑Depot w/o Food Preparation ❑In-Home Caterer ❑School ❑ Soup Kitchen ❑Vending Machine El Senior Nutrition EJCommissary ❑Day Care El Party Room E3 Staffed Vending ❑Frozen Dessert ❑Other (please describe); 8. Te of Const on: New Type c)sed Construction; enovat on ❑C onvcr stun to New Use', 9. Describe Pro 10. Is Single Service Tableware Used Eclu ivelf dishwasher here (r �o �,r w If u answered NO enter the make/model o (required): 11. Submit a Printed Menu. Plan review cannot proceed without a menu review. 12. Identify surface finishes below. Note that only durable, smooth and cleanable surfaces are acceptable. KITCHEN ➢ STORAGE AREA ➢ BASEMENT ➢ �.... .._.. g (gal)_Input �. _...�... _— ..... _ 13.Proposed Water Heater: Make _ Stora a al ❑ KW/H The enclosed"Water Heater Information Sheet'must also be cora feted. 14. Is There a Basement That Is Used for Any Food Related Activities? ❑ Yes ❑No Are There Any Additional Floors Above Any Food Related Areas? 0 Yes ❑No Drains Above Any Food Related Areas? ❑ Yes l No If"YES" htyt1ere Anoy ExposedWaste detailed eas�ohRoofr � ton �tp o�all exos!cd,overhead waste lines to food related areas. p g _. 15. Intended Total Seating: 16. Public Water. ❑Yes ® No (If"No", submit lab analysis) 17. Waste (sewage) Disposal System: n Public (Sewers) n Private (cesspools/leaching fields) The"Sewage Disposal Questionnaire"appropriate for the type ofwaste system must also be completed. 18. Tax Map Number: DistrictBlock Lot TWO Section ..- TWO SETS of scaled plans (1/4 in. = 1 ft.) must accompany this application YOUR SIGNATURE TITLE DATE PLAN REVIEW EE SCHEDULE TYPE OF 1:..51.. E VIEW F FEE LJ _ .... 0 16 Seats.Off-PremjSe.S f Aterer. $225 17—49 seats.Limited/Mobile Establishments, , . . $240 50—100 seats. . . . . . . . . . . . . . . . . . . . . . . . . .. . . $335 101 —200 seats. . . . . . . . . . . . . . . . . . . . . . . . . . . $460 201 +seats. . . . . . . .. . . . . . . . . . . $630 Non-Profit, No Fee . PLAN APPROVED BYa _.,. �DATE: BUREAU OF PUBLIC HEALTH PROTECTION Rev 6117 360 Yaphank Avenue,Suite 2A,Yaphank NY 11980 _ (631)852-59991852-5873 FAX(631)852-5871 BUILDING DEPARTMENT- Electrical Inspector w= TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 014 Telephone (631) 765-1802 - FAX (631) 765-9502 ' n role rrsot tholdtownn ov wand s tatholdtown ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: �,,rL 'Electrician's Name: r License No.: Elec. email: W S b I re nest an email co of Certificate of Compliance Elec. Phone No �3�— 3- 9�� q copy Elec. Address.: ' �� ^�cU� F'ocw 11 .. JOB SITE INFORMATION (All Information Required),/' Name: ` Address: Cross Street: Phone No.: "ermit email; BIgMaPDlstnct. 1000 '75ection: — Lot: Ta Map ( Block: _ BRIEF DESCRIPTION OF WORK. INCLUDE SQU E FO TAOE (Please Print Clearly): Square Footage: Circle All That Apply: Is job ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: YES E NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A # Meters Old Mete ❑New Service❑Fire ReconnectDFlood ReconnectOService Reconnect Ounderground overhead ' # Undorground Laterals1 E2 LH Frame Pole - VorK done on Service N Additional Information: PAYMENT DIME WITH APPLICATION