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Home My WebLink About20389-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20542 Date FEBRUARY 20~ 1992 THIS CERTIFIES that the buildin~ Location of Property 17475 MAIN STREET House No. County Tax Map No. 1000 Section 117 Subdivision ALTERATION NEW SUFFOLK, N.Y. Street Block 8 Lot Filed Map No. Lot No. Hamlet 18 conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 14~ 1992 pursuant to which Building Permit No. 20389-Z dated JANUARY 14, 1992 was issued, and conforms to a~l of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ALTERATION TO EXISTING STORE AS APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A SHAMROCK PROPERTIES Building ]~ns~ector ~ Rev. 1/81 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) Permission is hereby granted to: ...~...~....~..~.~. ............................................ at premises located at .,.L..~.,..,~,..~~.~,,,~ .................... ............................................ ~; .... .. . ..~ ~...~...~ ....................................................... County Tax Map No. 1000 Section ..... L/....~... ..... Block .....~.. ............ Lot No...../..~. ............ pursuant to application dated ........... .~ ....... ./....~........, 19.~.,,~and approved by the Building Inspector. Fee $..../.~....~. t.~..~. Building Inspector Re~ 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 bu%lding, 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. 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. C. Fees 1. Certificate of Occupancy - New dwell, ing $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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ........ ...................... New Construction ........... Old Or Pre-existing Building ................ ~ Location of Property...~...~?.°. ......... .~...~.-..~-.~.~ ....... i ....... '---=-~..j.y...f~.. House No. Street ~am±e~ Onwer or Owners of Property ..... ~ /~ ~ ~.!~..C-...f~..J.~..-f...~....~...~K.~'.~?..f~....~...~...~....~..~!?.~. County Tax Map No 1000, Sectio~ .... .~.~: ..... Block...~. ............ ot ..... /. ....... Subdivision .................................... Filed Map ............ Lot ...................... Permit No.../.~...~?%.~....Date Of Permit...~?=~.. ...... ~ Applicant ..................... ........ Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ...... ..~... Fee Submitted: $.....~.~..~...~. ............... FiRE INSPECTION REQUIRED BEFORE OPENING If copper tubing is .u. sed for water distributing system; piping shall be Of types ~ UH~F..RWRITERS CERTIFICATE .- ,',, RI'~QUIRED NOTIF ~UILDIN~ DEPA'RTMENT AT ...... ' 766-tl )2 9~-AM-TO 4 PM-FOR-THE FOLLO NING INSPE~IONS: ~. .c~.o~Tio.. ~o R~QUIR.O FIRE ROUGH - FRAMING & PLUMBING .,.a~'_ . co.st.uc~o, mUST 0PENIN~ ~,LL CONSTRUCT ON SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE~ CONSTRUCTION & E~RG CODE~. NOT RESPONSIBLE FOR DESIGI OR CONSTRUCT ON ERRORS JAN 15 ' FOU:;DATION FOUUDATIOt~ ( 2nd ) ROUGH FRAME & -FLUMBING I~;SULATIO~'~ PER N. STATE E~;ERGY CODE Fi:;AL i ~l/~ ' ~t/1 ADDITIONA'L COMMENTS: 76S-1802 ~ BUILDING DEPT. INSPECTION [ ] ~OUN/~ION 1ST [ ]~ROU~PLBG. [ ] F'IL~MING DATE /// ~/~, 2-.-.* FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-11103 Approve~..~.. .... 19~,~,Permit No.. Disapproved a/c ..................................... BOASD OF HEf~LT~~:'' ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ............ HAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 et~ 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ?he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections~ . -- (Signa'~fire of apl~Iicant, or name, if a corporation) ,~"2~_~'~.._ ~(e~ddx~s o~qal~plicant).~ ~ .~ ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncia~ ' n, plumber or builder. .................. ~';~ ............... ~ ....... .~2.;" ............. ' ........................ qame of owner of premises..~~ .~.....~..~~ ................................... (as on the t.ax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate office~ ~ Builder's License No ....... .'..~<.. ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... .....~..~~.~.. ~ ~. )~...~ · Loca~on o.f lan~d on whic~h prop,..~ose.d work w~ill be done./l . ;useNu;,; ....... ..... ...... .... ' ...... : " j .................... / 7 ~t 7~'" Ham,e, County Tax Map No. 1000 Section ..-~../.~'~. .......... Block....Ot~..' ............ 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 ........ ii'ii!i.iiiiiiiiill ....... ;i...iiiiiiiiii 3. Nature of wor~.heck which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ........ Other Work ............... : '. (Description) 4. Estimated Cost Fee . .t.~. ............ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ............................... 6.' If business, commercial or mixed :occupancy, specify, nature, and e~t'e~i 'o'f'e'a~'t~,;;';f'~ie' 7. Dimensions of existing structures~ if any: Front.....'~, Rear Depth .'... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth Height Number of Stories 8. Dimensions of entire new construlction: Front ............... Rear ............... Depth ............... Height Num6er of Stories 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ........ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......... ~ ................ Address .............. Phone No ....... , ........ 15. Is this property within 300 feet of a tidal wetland? *Yes. '~g"- No ....... *If yes, Southold Tdwn Trustees Permit may be required. 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 ndmber or descriptinh according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S ~~ .~.. · · ;'. '.,'. '.' ........... : .......... being duly sworn, deposes and says that he is the applicant (Name or inuiviuuai signing contract) ~bove named. \-- (Cdntractor, agent, co'rttorate 6fficer, etc.) ........ )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~pplication; that all statements contain6d in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the ap.plication filed therewith. ;worn to before me this, Pubho, State of New York , I~o. 495136o, ' '"~ ............ ~ ................... Quatified in Su[folR County ~,~ (Signature of applicant) Corem ssion Expires May 22, 19