HomeMy WebLinkAbout23794-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24846 Date JANUARY 10, 1997
THIS CERTIFIES that the building ALTERATION
Location of Property 6955 MAIN ROAD LAUREL, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 6 Lot 36
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 18, 1996 pursuant to which
Building Permit No. 23794-Z dated OCTOBER 31, 1996
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 CONVERT A BUILDING TO A RETAIL SPORTING GOODS SALES AND
ALTERATIONS TO THE EXISTING BUILDING AS APPLIED FOR & TO
CONDITIONS OF PLANNING BOARD.
The certificate is issued to L.K.C. CORP.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
—'�'la�L� � /- "r,�/
it 'ng Inspector
Rev. 1/81
Foam N0. f
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)
N923794 Z Date ....� 3/........................... 19.
Permission is hereby grao0d to:
+r� <... .1,00 .3..,�,�..................................
..............MWI... ..!Y
ofpremises located at .....16�:�. o.`.!L . . ..f.1^.:... .... . .............................................................
............................................................ 4 G! ....................................................................
.................................................................................................................................................................
County Tax Map No. 1000 Section ......../�/J-^�j� Block ......&........... Lot No. Sia..............
pursuant to application dated ......................SJ�.%•• •d.......•, 1Aand approved by the
Building
Inspector.
�
Fee S.,ch.LLP...Y.....
Building Inspect
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION 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-disposai(S-9 form)
3. Approval of electrical installation from Board of Fire Undarwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 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.
3. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1 . 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.
. - _es
1 . Certificate of Occupancy -SNew dwelling $25.00, Additions to dwelling $25.00 ,
Alterations to dwelling $21.00, Swimming pool $25.00, Accessory 'building $25 .00,
Additions to accessory building $25.00. usinesses a50.00 ;
2. Certificate of Occupancy on Pre-existing Bui'ldine - $100.00
3. Copy of Certificate of Occupancy - -24
4 . Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15q.0/0, Commercial 515.00
. .
DateT/��/101. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Jew Construction. . . . . . . . . . . Old Or Pre-existBui
� �. .
<. . . . . . . . . . . . . .
.ocarion of Property. . Zl ,% . . . . . . . . . . . ✓ i
House No./ - Street Hamlet
Mwer or Owners of Property. . . !!: `"`- :. . . <?J.P.•. . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . .
V0unty Tax Map No 1000, Section. . . . . . . . .Block. . . . . .A . . . . . . .Lot. . . . IT? . . . . . . . . . . .
subdivision. . . . . . . . . ilea Map . . . . . . . . . . . .Lot. . . . . . . . . . . . . . .
. . . . . . /
Permit No. .
171- .Date Of Permit,./'0/5� !�s . . . .Applicant. .CQ�n�!
lealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval.," . . . . . . . . . . . .
lanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . <
equest for: Temporary Certificate. . . . . . . . . . . Final Cernicate. .`X. .1. . . .
-ee Submitted : $ . . . Ally'!. . . . . . . . . . . . . . . . . . . . . . �/
S a yS G
C �aY��� pr, 1rAp'T . . . . . . . . . . . . . . . . . . . . . . . '
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PLANNING BOARD MEMBE � , 41 � M1
RICHARD G.WARD - p Town Hall, 53095 Main Road
l/ P.O. Box 1179
Chainn n
GEORGE RITCHIE LATHAM,JR. J Southold, New York 11971
w r Z �� Fax (516) 765-3136
BENNETT ORLOWSKI,JR. y T
WILLIAM J. CREMERS O Vii; Telephone(.516) 765-1938
KENNETH L.EDWARDS ��djQi
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
TO: Thomas Fisher, Senior Building Inspector
FROM: Robert G. Kassner, Site Plan Reviewer
RE: Brian Williams Bycycle Store
in former Ocean City Club
Main Road, Mattituck
SCTM x#1000-122-6-36
DATE: October 9, 1996
The Planning Board grants a waiver of site plan requirements for the
above referenced property.
A review of the project shows that the bycycle store will not generate
additional requirements for parking, as it is not a more intensive use of
the property. This review shows that adaquate parking exists for this
proposed use.
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
o ; a S�
DATE Z 76 INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ) ROUGH PLBG.
[ ) FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE INSPECTOR
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+ BOARD OF IIP:ALlII
I'OIIM N0. I J SI's'I'S OF l'LAN: . . . . . . . . . . . . . . .
2 h b I' TOWN OF
, SOUTHOLD SI11iVgY
�'i BUILDING DEPARTMENT CIIRCR sem: d'7.'�. . . . . . . . . . . . . . .
TOWN HALL SKPTIC FORM
SOUTHOLD, N.Y. 11971
p
'fP.L: 765— I002 NOTIFY:
I'.x:xnllN•fl /...., 19J,� ^ MAIL TO: . . . . . . . . . . . . . . . .
Approved,A14t...., 19�i.' I'ennil No. ......... ...I .............. ........... ....._....
Disalgamocd a/c ............... ............... .... .......................... ..... . . ...
......... ..............
(Ikri ldiug Dv:Ixrlor)
' LIGATION FOR BUILDING PERMIT
Date. . . . . . . . 19
INSTRUCTIONS
a. 'Ibis applicakAoo srrnC be cuigrlelely filled In by lyliewriter or in int; and suUnilted to the Building Inslx'clor with
3 spin of plane., ncc urnLe plot. plan to scale. Pee nccording, Lo schedule.
rb. Plot- plan allowing l(calA nl of lol and of buildings mi prownises, relal iou.hip to adjoining pronines or lxfb) ic
slrppin or areas, and giving a detailed o1mc:ripl.ion Or Inyafl: of properly sant be drawn on the diagran which is part of
thin' algrlicnlion.
r
or. The work covered fry this application 1my not he coneoced before issuarice of Building rermil.
d. Ulxn approval of Oils applicaLlon, the Hailding InspecLor will issue a Building penult Lo Lhe applicant . Such
lennit: shall be kept. on the premises twat Wile for Inspection l.hronghalt Mie work.
e. No building shall be. occupied or used in whole or in fall for any Purpose whatever until a llortificate of
Ocrufnnx7 shall have been granted by Ole Building Lrspeelor.
AlIVIACNI'ION IS IIICIIRIIY 111\06.lo the Building Depnrinrnt for the issuance of a Ikrllding Permit forsunnl In the
Building %coxa Ordinmrce of the Town or Solhold, Suffolk Cafnl.y, New York, and ol.her arylicable Laval, Onlinmfcor. or
RegolnHoorl, for I.he constrouion of boildinga, additions or alterations, or for rrommal or denrnlition, as herpiu
described. 'the applicant, agrees to cufgdy with old arriAlmlbde Irma, ordinances, hoilding axle, lousing code, slid
relgrlathmm, laid 1.0 adolfit: Fn Ih riled inspectors On pr Ennl.^,en and in Wilding for necessary inspect ions,.
(Sigoraore of applicant, or nark-, if a cotlnral.iou)
(Moiling address of applicant)
Strip whether nlyl icant is owner, lessee, rtgenl, nrchitecC, engineer, general contractor, electrician, pdauixar orhoi Idol .
e5Se_.2...........`........ ........................ .. .................. ........ ............. ...... ... . .....
Ncrr of owner of prunisen Lf (my.e.............. ........... ................................. ............ . .
(ss cif the lax toll or latest: deed)
2(mw In-gill is a cortmralirnr, signaturerm
of duly lbor.
rized officemol lit le of corlxrrnle officer)
guilders license 10). ... .. ....... d'S�'.^... .'>�
Pdudaers License No. .....:"'-:......I........
Eleclrieinna License No. ...... .. .............
Ot.lnr Traxle's license No. ....................
I. L/rr'otion of land co which pwofxsal work will he done........A•.wn... . . ..... .�.,oli. ......1....... . .... .. .....
... ...... J........... ...........I!!f^ e�.. 1. . ..... ........................ ...� V!�...!.........!.. ��� .. o
IkAlsw fkllioer Street- Ilrndet
Comity Tax Kill No. IOUO Section[ %....... mock ..,..�......... 1.01' ........
Subdivision ........ Piled Kip No. ................ Lot ........... ....
(Kan)
2. Stale existing use and cccuria cy of prunises nod intended use arxl occufuarxy of profxrsed consbucl.ion:
a. lixislAng use anal ocrofxux:y ....UnSC.G.w, .5�:... .... ... ........... ..... .......................... .......
b. Inlpixlal use sfxl axYwlnrrxy ....!`.�+.�-f'V�....cS. Q�C� '`^ �,,,,�,�.Q ...
-.. fK)»ru .tit.lai...................
YRAIMIJ
�3lIUt}.)Fffrr$PApc".��:Ii�i'1'i'^.[P�
_.et sot vi�i n�"sir�aa i snout
.slur(! oI' tank (check %Alien aIIA icable), Mat Ihlildinl. . .. . . . .. . . Addition ... . . . .. . . Alleralion . .PC. . . ,
Itcywul Ihmrtval �',. .. . ... . .. ikmnlll.lrnl Other . .... . . . ... . .
4kok . .
.. .. .. 5. .. . ... . . . . . . .
(l leacl"ipl.t(xl) '
4 . I(etl Iuwl(ed Cost . . . S.:W.I,.... .. . . . Feu
(lo Iw :olid on filing this appli(:Ill:Ion)
'i. 11: Ihx:lI fill;, Ixniwr of ()kash ing, units fhnbrr of (haclling wills (x$ earls fI(for . . . . . ... . . .
1 I gm ,C. Ixld Na' (If CEll if . ..'.-i
cls L . . . . . . . . . . . .. . . .. . . . .. . .. .. . . . . n i
fi. 11' Ixwilwss, c(Inwiclal u" ndard a:colwlwy, slx:cily nalule 1110 and r:ul. of carp lylx! of use...U`�..'4,t'.\�.,. . . . .. . . .
Ik:l � d . .. . ... .. ..t... : .. . . ....�es, i l' euy: Ih ons .. . . . ..1.) . . '. . .. Hear � � .. .. . ... . . Dept 11 . . . .l~.g. . . .. . . . . .
/. Ik!I i Ions of .7 Ing sl . . .. � Mni>er ol` til urien . . . . . ... . . ... .... . . ...
Uier:nst 1'11 of nine sl nuaure wliilh al Ieral i(xls or o(Id 11 ioua: From . . . . . . . .. . . . . . . hero' . . . . . . . .. . . ... .
Ih:plh . . . . . . . . .. . ... . . .... 14!il;rl( .. . .. . . . ... . . . . .. . . . tdldwr of "lories
If- ililmoll I(xill of col if(! Ixnv cooMf,Iw:l ioO: Ih(xd . . . . . ... . . . . .. . . Ik!Eu' lkaplh . . . . . . . . . . .. . .
Ilolttlll . .. . .. ... ... . . . . .. . . ....1. Mnhcr ill' ';lot fel
. . . . . . . . .. . . . ... . . .. .
( t
9. iiz.a of Int : Ih(x\1 ... .�1 S. .. . . . . .. . Roar . .. . . ..,. . . . . :. .. .. Ikplll
I0. 141111 of ILn.hns(a '•i.. . ... . Wtw! ol` Folnr!r Qawl' .. . . . .. . . . . .. . . ... . . ... .. .. . ... .. . . . . .. .
II. ylxw or use diel ricC iu Idlich lircrllises Elie ai1'ualed . . .. . ... . . . . . ... . .. . . . . . ... ./.. .... . . ... .. . ... . .. .. . .. . . . ... . ..
12. Ihws pullxtaecl r(xa+l SWILi(w violiale any z(xling Ilea, oldioanre of. regolal.ion: . . . . ... . .. . .. . ....
I'). (Jill Int iw rn rtw'd � . ...... ... Will excess fill IM rrelravecl Pnyrn preyni sea: YI?fi J:)
let. tlallxa of Iht(wr of naniaul ,KvM� �?VC{�fU�. ... lddl �S.4S L... ..���.U.. . .. ... Ifiorx Pkl.
I) . .. . .. .r . . .
Nrrin of Ar<:hIU!c1 . . .. . . .. . . . .. .. ... . ...I M4lteaa . . . ... ... . . . . .. . .. . .. .. ... .... Mono Mr. . . . . . . . . . . . . .
Horr! ol' (awlror.lor ......
... . . ....... ...... . ... Addrees .. ... .. . ... .. ... .... . .. . .. . .. ..)11otw M).
h. Is Ii1l!I+If1Yf9,rly Within
'IIM fe c of: a tidal welhind? A YIN . ... . .. . . . M)
I I Y
" ` S IaLS MINT MAY HI. HIC(X11HIi11,
1
PLOT I)fAMIAf1
Itx:ato r.lenlly nlul dislAtwi ly 11i11 Ixlildinga, lAlalher exhaling or prolxleed, alul ilwlieala all see-bank db(rnaiuns
I'mll Illotwlly Illw!1. Give al.trel: 111x( hl(x:k IYrliwr or defictiol loll ticcordlllg to deedi�nh(l all(V street oi11r,!tl t11w1 Ilwll(IEI(e
1du!Ihe1 inlerior or coli.[' lot..
Slut
GI'NII': W IN-V Y(Nll(,
(Willy W
.. . . . .
of it C(I ul ign i r.('\\Iactl /5. . . . . . . . . ... . . . . .Iwing duly tnxan, dotxlses alwl anya (hal he in the 11ppiirnnl
MKIve mmwil,
Ilr. Is Ilu! . . . . . . . .. . . ... .. . . 4�ClAL . . ..
((k,nl Incl or, ngeol', ;corlxa nle officer, et(:.)
of :olid (xalwr of (xti x:l s, 1110 in duly iaulhorized to lx!rfunn or havo Iw1"fonlw!d Ilse flight w•Euk 1111(1 to nxll(o olxl file Illis
uppl ieul ion; 111111 rill 11tki(owul11 cout�ailwd in 111111 oppl iral ion ale t llw to Ihe, bestl o1' hits klwwticdge. nld Iwl icl; nlxl
tial the Inuit will Ixl lxdlfonn!d in Ill, 11wewwr wk fordl to Ihe nppliciltiou tiled lhol(wtlih.
;Hann to I10ole. fly! Illia
. . . . . .�PT(`t". . . . .(h y of . . .. . . . . . . 9.�'F�. . .
M)]aly I1lblic . . . . .. . .
ROBERT 1.NOTARY ..
PIALIC late of NI (Sil;nnof
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