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HomeMy WebLinkAbout19862-z 4 ~ ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20090 Aate JULY 18, 1991 THIS CERTIFIES that the building ALTERATION Location of Property 55 COUNTY ROAD #48 MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 121 Block 2 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 18, 1991 pursuant to which Huilding Permit No. 19862-Z dated MAY 15 1991 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 ALTERATION TO STORE #2 FOR PIZZA PARLOR AS APPLIED FOR. The certificate is issued to MIDDLE ROAD SHOPPING CENTER INC. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N~A UNDERWRITERS CERTIFICATE NO. PENDING - JULY 17 1991 PLUMBERS CERTIFICATION DATED JULY 18 1991 - LANCE PLiIpffiING & HEATING uil ing In.,pec~~ Rev. 1/Sl irORlt NO. A 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) N°- 19 S 62 Z Data ................Y.Y..~....l..s~........., 19.q..t. Permission is hereby granted to: `~30 "lu 3~'.... ....1.....~ to .....~..'.'."`.g^•!M".:~...~...~~.... ?,~...1J.4~X:P1.~....Rna..... ..cY...JF.:~ cs~~,,a....a~-~:..~~~ . of premises located of .......5 5 .....1.4~kT.... ~T.A......~.9 e~~r~"4k~,.,.............. ..~i:4:::....~,~-.~ :..................................................................1.... County Tox Map No. 1000 Section 1 Black Lot No..~?...~ pursuant to application doted ......~W...41:.1'.1.........~.~.........., 19.~.~.., and approved by the Building Inspector. Fee s.•)•~....'~~ . . Bu ding Inspector Rev. 6/30/80 Form No. fi C7f ~D °J~ ~0' ~~c~ TO[JN OF SOUTI[OLD , BUILDING DLPARTPIENT ~ ~ TOWN HALL 765-1802 BLDG. DEPT. TOWN OFSOUTkOLD APPLICATION FOR CGRTIPICATB OP~OCCUP,\NCY This application must be filled in by typewriter OF, ink and submitted to the building inspector with the following; for new building or new use: 1. Final survey of property faith 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 Pire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2J10 of 1~ lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code C,;mpliance from archi_ect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) rion-conforming uses, or buildings and ~~pre-existing" land uses: 1• Accurate survey of property shocain;, 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 Cuilding Inspector shall state the ' reasons therefor in writing to the applicant. 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 $2.00• 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 S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .7~~~~/.. ^^-w Construction....,~Old 0 Prc-ex " fisting Building., ocation of Property,••~J~••• C~. Rouse No. S Street Hamlet~• rover or Owners of Property.. ,unty Tax Pfap No 1000, Section.. f Z, , , , , , ,Blodc.....z'- / .......Lot.......(...... .bdivision..., " " ~ri ................................Piled Map....•••...••Lot.. rmit No,! • „Date OE Permit.. ..............Applicant.............. ulth Dept. Approval..... .....................Underwriters Approval............. _nnins Board Approval :uest for: Temporary Certificate........... Fin.rl curtitatc..... ' Submitted: 5............ c. o ~a o o g o LICAAl' _ 6~~lco~ ~ 48~4a'~ cod ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS P>,Gr•' ` 1pU1381 BUREAU OF ELECTRICITY AUGUST i1 , qq~3 JOHN STREET. NEW YORK. N~N( YORK 0038 14 71?"1 0:17 Date Application No. on fife iqh 7 1 q'I 91 THIS CERTIFIES THAT only the electricd equipment W dsecri6ed 6elore end Introduced by the applicont named on the obooe applicstion number in [he premises of PRIMAVf;RA Pl7.ZA & YAS'!"A, MfUU7.F; R«All, MA'i'TT'('tICK, N.Y. - t in thefdloRCinp I.N>o~~ItS,P1~~ftt ~ /st Fl. ? Pnd F'I. Section Block lwEt - uwa examined on andfound w 6e in compliance faith the reyuiremen[x of this Board. RXTUR! E?TACIlS SWITCNES RXTURlS RANOES COOKINtii D[CKS OVENS dsN WASNlRS EXNAUSi FANS OUTLETS INCANDE]CFNTfIVORFSCENT OTNEP AMT. K. w. AMT. K.W. AML. K.W. AMT. K.W. AMT. N.P. 7,1 8 9 t 3 8 7 t DRYERS RXINACE MOTORS NTURE APNIANCE MMES SPECIAL EEC'PT TIME CLOCKS RlLt UNIT NEAttEi MULTI-0UTIET DIMMlRS AMT. K. W, dl N. P. GAS N. t. AMT. NO. A. W. G. AMT. AML. AMi. AMPS. TRANS. AMT. N. P. SYSTEMS AMT. WATTS tt0. ~ N!T 7. h0U SERVICE DISCONNECT NO.OF 5 E R V 1 C E AMT. AMP. IYPf tI0U1R 1 R EW I 1 ]W ] 1 ]W ] 1 AW Oi CC. COND. A. W. G. NO. Of NLLEG A. w' G. NO. OF NEUTRALS A. W.G. PER B Of CC. COND. OF KLIEG Of NEUTRAL OTNER AMAl1ATUS•. ~ PANFi,BOARDS:7-tf, CiN. 1i10 r,.~'.r.r:-3 L C I° I- b~ 3OpY PUMCL6U I.iC.$7,300-X YAT [.ANF: MATT7:1'U< K, HY~ lig5~ I i OAI~At ~ Per This certificate must not be altered in any manner; return to the office of the Boord if incorrect. Inspectors may be identified by their cradantialt. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MAINER. ~~FFO~.C TEL.7G5-1802 o~ol!~, o~~ To~rr or so~~~oa.~ f•--" ~ ~c OFFICE OF BUILDII•dG INSPECTOR ~ a'' °r, ~ r7,: r;, P.O. BOX 728 D tJ v~ e'~"',,i 'r TOIVN HALL ' oj~`~~~o~ SOUTHOLD, N.Y. 11971 ; ~ TDWN OF SOUTj jpLD C E R T I F I C A T I O N Date Building Permi/t~ No. !~(.9 Owner fFf1G1C~ I-GOM(0 .n9 t t~e~,`t'~~,~ (please prix/nt) Plumber //,Ulf'V'2~/ f1 i~ f' (plea c- print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. (plum is signature) Sworn to befcr )mc this , -f-~--d a Y o f i~~Z~_~~ Notary Public notary Public, County p0RlS #4A411E y,4RR~a • • typ~rg P~'a5c. Stafa of td'Fr~ IAr. 845 ~ ~ ~ ConuritdrM ~ 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: DATE ~ 7 7 INSPECTOR ACPIQd ~ ` ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES PAGE -e¢'~;?.~g~ ? ~,o tx v tn+i ccrx., .orm: x armicFOOD ESTABLISHMENT WSPECTION REPORT ~ OF u. 2vn/'n~~i^l.1ln ~'+vv~ .4R W4WLUne ..xn : n. ~ . 91 ~ 1 1~ T NEHICYf 162` FT'J ~ i y~n4l d'Od ' _ - ~ _ a e :,v~_ - ~ K _ ESTAB.,~ID. ;etret7ant raen ~inva Q ESTAB. ~ L' . ` _;j ..5~~~~.~ , , r.r.. . DATIVE`' Y PRES~'TRT Oi~T16R'S ~ ~.~va:,un of : ..w , , ~ i-:,. : ~ coNAME Pt Ott # - s NAME N ZIP o, WAFER SENIIiGE FROZEN ADDRESS ~ ~ irc ~ ~ .v ~ CODE ~ / J`ry SUPPLY DISP. DESSEIYP E'er' INS ION '1, TIME OF -PM WATER SAI~LE Nn. DAY YR. 7 / ~ i INSP. DATE CHOK~I~SIGN YE5 ? NV, ? ~OION YES ? NO ? CtISfSSIFICATIONI ? . 2 3 ~ ECTION } ~7/ •~i/1T ~fn?/~~~ PART 1: FED CRITICF.L ITEMS _ Y1Vasu FWVS NO• •Y 11]El' ~ i ..r `=I Ftli. `,hiA DESCRIPTION OF VIOLATION INO.N. THESE ITEMS-RELATE DIRECFLY::TO FACIURS WHICH~LEAD TO FOODHORNE TI,LNESS AND MUST~RE'CEIV'E ~LRfi1EDLATE AT1'ENPION CORRECTED _ c~_m.,x:: o;::o _ • ..i' is tr• C:,yYbp Jx vpP a. <4ia~3c Jn_,.~ u, . c.p} --o>_ _ --yyam~ h .uNwb: ~ / S ~ 01/ r L~ !f _ ,oat a i1~r ~ , .~r o' _ , . ..ore xa.~.:°: ~rst~~~~luex tevxc. av .~°u-; 'r,„ :nrr. ~r.-: ~ war,. ~ :..e fn CM1 Rt 1n_ zPJ.._ 1 : V. i l : , . _ _ _ _ r~:^' ~ - s. ~ rat aEr. 13G. 11" _ _ J.. i . . rte, ~ ~ t~rc :'i a~ : ' vrr -.-.aa ear, _ _ - aN .~..i.i.... v ~ kO:E ~p LYt "/:F= t-~.' vln+i iU r, a = .n .rv, _ .u . _ l _ PART 2: BLUE MAINPENADICE ITEMS _ _ _ VIZONS NIO~ :.ur.q,~ r.c.via•, -•wc - ..rc,r..... .a r.., ITEM DESCRIPTION OF VIOLATION CORRECT - NJ.. 'THESE ITEMS RELATE TO MAINPENMA~ OF THE FOOD SERVICE OPERATI~J A[=ID CLEANLINESS. CORRECT AS SC11E•D[Rk'D. BY - 9~~~ • ~ ` ~ x _ -rv 57F, ds~~ ~ - l/ a- ,r. ~ ~ ~ c r s w ~ THE MARKED ITEMS ABOVE ARE VIOLATIONS FOUND DURI.IG AN INSPECTION OF THE OPERATION OF TfiE FACILITIES IN THIS ESTABLISHNIENF WHICH MUST BE CORRECTED AS INDICATED. FAILURE 'IV OMPLY MAY RESULT IN THE INITLATION OF LEGAL ACTION AGAINST THIS ESTASI,ISIAiENT AS PROVIDED FOR IN ARTICLES 2 AND 13 OF THE SUFFOLK COUNTY SANITARY CODE IAYS.UDING A HEARING, POSSIBLE SUSPENSION OF YOUR FOOD PE -ION, AND OR THE P= ICATION OF THE VIO ION FINES. SRECE~IVI~NG REPORT i ~ TITLE •,i7 t~ ~ ( ~.I IMES"TATUISN U T { 1 i. - ~ , f { : . A t, 2 i . ' Y l.- B-' F-t H re F' ~ g. 6.Y4'~2 iE $ 9.J 6.8 P°~iJL~ J~ ~I ~~h~ ~ a r.~~;m~Y- ,~.'r~F~ {,'.Ui'rd1..P' CS;N,IN'(1' E'X£ClJ?iY~ Dk. F'A14"Mk;NT Apr 11Gi, i.YYw ~4~t~Vi%4.:J I?A ~h© HA~"tas. M.Cl., M.7 w, ~7~~ X ~ a. 7 {1 t 1 9`,`31 cnnM~ys~onew ^l.tf~Cl~t? Ci(ai3r.9c r3X1ti;j"?~:,s y°I i„^~ isY"'t'' .1.P.C. 1 ).0 i2UUi:.~ 9$ ,rn r„ i 1f: Ut:nq s,' '„'C: : 't-: f Il~~.w ~G'. Y'~C ~ E~lllC?St: TP,is ~?~partmen*. f,~1~ r~Fri~~~~; tr~~a plans, suhn3tCed by you frr the fc~ilowirrg ~4'ood`'ai;iti~y: M.ic3f~7..~ Ft~;_t~3 ~hr,~~,~,r~c~ ?~c:nC~.~-d, Snc., (~izz~}, 120 ~zctu~~+ 43, ~9c?tt_#.~~'u<.R The Owp.~r°trn~ni. ht++~; w~+~;rovccf the ;>lans as ~u6m4tte~ wins yhe tallo~~inc rrncli r ~lcat i0rrs: ~ lra:~r.r;x• s=rcf',m :a l:~t-`e;^.s~:~'4 ~3.LZmhez' ver~~S'~n~3 car~»ec:ei~x~ t~ i`r ~ ~r~rl; 1a~;~ sunrnft~ed ~~:irs c,~fi.<~17 r}xi,:~z CC+ nl>cjrati~~n Hot•!@YE1"3 b€~ft?Pi'• c;<aY15:rt,C;,i:} ~ Jt~~Ui? it iriay be n~'G255av°y fotY yyJu Cv ~~,tain hsilf~in5 ~~d,^raif fl-;,,;r; y<us" local t,~ilding departmer7t. Thr~ enrlPl~~r_af pe,r~,rft :appllca~io~~ is to be co~~~et~ad and returned a~~~;i,t l;en flay, vditf, ;~'cinr permit f`,;w t.heok for ; , ,n Lh~^ p;~,~iused anvtai;~pe• Approval T;~~ e,perate your est~irallshment will be gluon 4per 5:rts~i'c~4;COr'y ;;Ia,rnlalaci~Wn aE tP~e lns~~a"station. Such constructiUn 7t;all tt,la ` f9 ;,on;plet~ :+SrrPurlnl>y tr4:h ~u1re plan; ar;d s;7ec„„fflcations apprcwe~i tfri~ ;gay cr app;•~'~ve- moaificat9ons thereto. F9n~:1 ar~~,ra a1 is ~In"'in~,ont upon receiving cert5f9eation of the sewage <tisprisal e. ar~l,~`n;+.ati,~tion oy the Environmenta3 ~eryineer~?n~ Sec:tif~n.~P~ ser"~"~~ ta<.t 1~1M•. Robert Jewel I at (57b} S~~»3315. Yc is ner,essary t:ria~ yqu :nalc<; an zppointr=ELnt for final approval insnec,- ~•.ian at ~easa nne we~~° M~;`fre ti;U ar~ticipatetl opening u~ate. `tour fa;lure t:r, dcr sn Cossld rr~sulG in delay of said opening. Very truly yours, F~~`~iskaCana~t Senior Sanitarian Fh.jhb p~'3~ 307E G~j a~ ~`t ~~~•s e. y, ~~.a.+-w-~.,c,.~„-„. 6 L`U~•.YV C¢^.iC~ alvrft.,g ~A N. v, i.9(3t t_ - :1 E. t f i--', bl _ -r: rt }-y Gt 5. 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Y't:3'~`SS: ....~g ~ ~ atail IR?Ftt+£3"~' A)~StYU{~ tS _ . _ K,IA~'E: r._..._ ` CtJ) v',~• drab; `K_et ~~w _ m REPAIRS LANGE Licensed & Bonded ALTERATION Plumbinor & Heafin ~i~l' . 737-0991 NEW WORK b g p 2140-8 Pond Road Ronkonkoma, NY 11779 _l -~-wvw~.~~ tF-- ~ T " !i Y / ~ / r1:;LD I;:S:'~C;iU;7 ~ ~~Un^E ~ i:OMMENT~ 1 ~ lT7 r ~ l ~ ~ ~ y FOUNDATION , (1st) m - c~ FOUNDATION (2hd) _ _ m ~ ~ 2. rf- ~LF..z® =off- , z ROUGH FRAME & ~ PLUMBING 3. ~ ~ ~ ra m IidSULATIOii PER N. Y, ~ y STATE ENERGY CODE . x .S a y ` FI7JAL p z ADDITIOiIAL COMMENTS: m x . ~r x . ^o ~ H H O Z . ~ x m • y S 3 t • ~ ~ ~ m N , H :+fa::zb rt..«k4~H'.. .i;~:,..:'..~... ,,,.f~r'~..c.~`~:s„A~ xx~::?.~. .~~»..,°k„~.:.~,.~acx~,...;.v~..~uwt:+~~.~~r~~=~~ ~'~uaci$,~ y~'µ ~4k. x / I~~Z- k r ~x 765-1802 BUILDING DEPT. 1 NSPECTION ~h [ ]FOUNDATION i5T ( ] ROUGH PLBG. ' - [ ] FOUNDATION 2ND [ ] INSULATION ~ [ ]FRAMING [ INAL R MA K E R S. d DATE ~ ~ INSPECTOR rte. ham °t'' +.~~.an5dti3a~5"~a'.~GM1s.i4a..vtaa~v-'~:,~6+, ,.~.~&>>n:'u...~ a'~ COUNTY OF SUFFOLK as°- P tg~.Pr~:. ~S 7,~~ D9 Gg2X fS12c :4X Kffi6 iFkW dux SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES DAVID HARRIS. M. D.. M.P H. April 10, 1991 comMiss~oNER Middle Road Shopping Center, Inc. 120 Route 48 Mattituck, i4ew Yor1c 11952 Gentlemen: ,This Department has reviewed the plans, submitted by .You for the following food facility: Middle Road Shopping Center, Inc., (pizza), 120 Route 48, Mattituck The Department has approved the plans as submitted with the following modifications: A letter from a licensed plumber verifying connection to the approved extrior grease trap be submitted to this office prior to operation However, before construction is begun it may be necessary for you to obtain a building permit from your local building department. The enclosed permit application is to be completed and returned within ten days with your permit fee check for g 120.00 in the enclosed envelope. Approval to operate your establishment will be given upon satisfactory completion of the installation. Such construction shall be in complete conformity with the plans and specifications approved this day or approved modifications thereto. Final appr val is onto gent upon receiving certification of the sewage disposal yt t~m a s installation by the Environmental Engineering Section.. P-~le~as clntact Mr. Robert Jewell at (516) 543-3313. It is necessary that you make an appointment for final approval inspec- tion at least one week before the anticipated opening date. Your failure to do so could result in delay of said opening. Very truly yourfsj,~ ~~~~i~~C.-' (~J~%~Z~ Flizabetn Canal Senior Sanitarian FL:jhb Enclosures 548- 3078 COUNTY CENTE9 A~YERHEA D. N.Y 11901 ~00[lNl'Y DEPARTM@Tf OF HEALTH 3ffi2VLCBS FOOD BSTABLISfi~7[~J1' P~d•IIT APPLICATION For OPfice Use Only ANNUAL FEE [ ; ; ] Class. Code ew ?Renewal ?Change ~/~T~~ ~ [ ] Conditions Il•II~fANT [ / / ] Issue Date Complete both sides oi'~,le appplication. This application must be submitted at least fifteen (15) [ / / ] Expiration Date days before the first day of operation. Processing of your application will be delayed if it is [ ] Estab. I. D. incomplete or illegible. Approved by PLEASB PRINT US6 BLACH INB ONLY - 1. Name of Bstabliahment(D/B/A)*: Street City Zip Code• Phone No.( ) - 2_Type of Ownership: ? Individual ? Corporation ? Non-Prefit ? Fart.iersiiip 3. Billing Address: (This section MUST be completed) Name Phone No.( ) - Street City State Zip Code: 4. Personal Mailing Address of Person Signing Applicationt: Name Phone No.( ) - Street City State Zip Code: ; 5. Corporation Name aryl Mailing Address: Name Phone No.( ) - Street City State Zip Cade: ; 6. of Establishment: (Check the approppriate box) staurant (Eat-in) ?Restaurant (Takce-out) ?Delicatessen Qfavern ff Premises Caterer ?Frozen Dessert ~lunic~ipa1 _ ?Balcery State Property ?Non-Profit ?Food for the Aged ~JSchool~Caterer(?Otherofit) ?Commissary 7. Frozen Dessert Mac~h;.w; Ayes ?No (If YES, see reverse Item #7) 8. Maximum Occupancy Seats Provided: ?Yes ?No Number of seats 9. Tax Map Number: District Section Block Lot The applicant hereby agrees to operate the food establishment described above in compliarre with the requirements of the New York State axd Suffolk County Sanitary Codes and hereby authorizes officials oP the Suffolk County Department of Health Services to inspect any and all premises and take samples of food therefrom for laboratory testing, FOR OFFICE USH ONLY Signature Print Name Title Date * The application must be signed by an Officer of the Corporation, Partner or Owner (See Item #4 above). The D/B/A must be completed before a permit may be processed. (See Reverse for Instructions, Fee Schedule and Insurance information) s r~~ ax~rrrr nmaArr!~r:° ~rsg s~RVn~s sa~LB of r+~ FBBS \ TYPE OF ESTABLISHMENT t1NN[]~FEE** Tavern (No Food) ' Delicatessen $ 85r Frozen Dessert Off Premises Caterer $ 85,OQ'"'° sFood Service:;' 0 to 49 (Occupancy} 85,00 50 to 100 (Occupancy) $~g• 0._~ '101 to 200 (Occupancy) $195. ' 201+ (Occupancy) $225.00 Food Commissary Bakery $ School/Caterex Vending Machipe Location $ 50.00` Non-Profit (Attach copy of tax exempt form) NO FEE x Occupancy ratings are i{~ accordance with New York State Uniform Fire Prevention and Building Code. (See Item #8 on reverse side) st See Item #7 below. SUBMIT THE CXkYPLETID APPLICATION AND A CHECK GR MONEY ORDER (PAYABLE TO THE OQ~PffgSIC1I~Tffi2 OF HF.nLiH ar'R'i2LiCO"""ia) IN Tf'.E: PPE-P_DDR><SSF,I) ENVELOPE. (Required T^~++^~.^^° 7nformatiau: (See Item # 8 below for instructions) Disability Ins. No. Workers Comp. Ins. No. Company Name Company Name Or Attach Approved Workers Compensation Waiver Form C105 INS1R[JLTTON3 Item #1. Change of Ownership?: (Please provide previous D/B/A) Previous Name of Establishment Previous Establishment I. D. # Item #3. If your business is operated under a corporation, provide your corporate address to insure receipt of all correspondence concerning your food establishment. Itau #5. Provide a permanent or year-round address to ensure receipt of your renewal application. If the renewal application is undeliverable, it may cause delays in reopening your seasonal establishment, or continuing your year-round business. Item #7. An additional permit is regwired for the manufacture of frozen desserts. If you checked yes to ~.tem #7 on the reverse side, yqu must submit a separate application and,fee. Item #8. proof of Workers Compensation and Disability Insurance or an approved waiver (Porto C-105) must be submitted to this De tment. Contact the New Yorlc State Workers Conpensation Board for requirements and applicability (51G-486-4300). *NC1fE: A permit cannoti,be issued without this information! Return the compplet~ application in the enclosed envelope with your check or money order. If y u did not receive an envelope, return the application to: Suffolk County De t of Health Services Food Permit 225 Rabro Drive, Bast ~au~ e, New York 11788 PFio# (526)-348-2774 Additional Infozaation Call: Call• Riverhead District Office~at (516) 548-3076 Smithtown District Office at (516) 360-3000 For Tocroships: Brookhaven, Riverhead, For Tocroships: Smithtown, Islip, Babylon Southold, Southampton, East Hampton, and and Hunting on. Sha ; ; Island. ~ ~ Rvv• 1 /9Fi/RQ COUNTY O)' SU)=1=0UK ~J , PATRICK G. HA4?IN W/l OLK CU4b1Y KA wbNfIY[ OL'HAHTML'RT OM FiIALTH GL'RVICCtJ DAVID Hwnnls• M.D. M.N.H. • i..w.«•...w..w • ( SCIIEDULE OF FOOD FEES EFFECTIVE JANUARY 1, 1490 '1'YP[? OF 1•'.S'1'AnLTSIIMI?NT ANNUI4T. NEl? 'Tavern (NO Food) $120.00. Delicatessen $12Qr00 Frozen Dessert $145r00* Off. Premises Caterer $120.00 Pood Service: 0 to 49 (Occupancy) $120.00 M 50 to 100 iOCCUpancy) $175.00 l01 to 200 (Occupancy) 5250.00 201+ (Occu~lancy) $J50.00 Food Carunissary $250.00 . Aakery .$120.00 School/Caterer $150.00 Mobile Vendors $ 75.00. ' Vendinry Machine Location $ 75.00 Non-Profit (Attach copy of tnx exempt forat) NO PEE ¦Includes $25•Frozen DeOSert Manutacturinry Fee l]1 nw.n0 W11rt [wY7 uw.u•Pwwl. 117.. .u w w•]rW ~ 3 0. r ~ ~ T ~ ~ ~ ~ u/lJL T ]m ~ C~ O~ ii - ~~~I~ ~ ate/ _ ~ o ~ ir=, 0 5 ~ d~ ~ x ~ ~ R ~ ~ ~ ` I i O I I .I ,R R i i I~ r a tab ~ ~ z ~ ;N ~ N ~0 3 ~I ~ x ~ ~ m ~+y5 ~ ~ ' ' ~ vJ ztyk i?Vm~ i'/~+o ,"rz . E ~ Jrn~ I~~1'\ stn ~ I+ ~ ~ )i ~ --------j I' t , , ~ 7, .`yj ~ i ~ ' K Hctr~1 `p ~ ~ ' t +VO ~ ~ ~ . r ~ c: ~ ` ~ ~ M r. ~ 'S ev ;o~ ~ z i. ca N~ -G'sZ \ i ff I ~ /~~r OZ ~i 11 y y~ T Z N ~ it ~ is ~ -aa - \ V REPAIRS LANGE Licensed & Bonded ALTERATION P/umbing & Heating Corp, 737-0991 NEW WORIf 2140-8 Pond Road Ronkonkoma, NY11c7~79~ _ ~ ~ ~aRE~}5 ~ ~/ti~ 5 . _ - - a{/~., St/f=f' Vin, i i y~`{j'+~ J ~ ~ ~ ~ I j '1 ylr'~v~ / ~'1 1ANGE PLUMBING & HEATING CORP. I I I y ~jA 2140.8 POND ROAD ~ RQ~{KONKOMA, N.Y. 11779 l i ; X37.0995 I'~4' ~ i W E7 ~ ~ ~r GT' ' ' ~p~L,'t~~ I I b SINS a ~~r1~ NiU P RpQpth~ i ttR~ ~~PS`N~ t_Q ~irJ'L. ~~Go St"'b 2 ~ co. 2" ~ q A ~ah~ 'yR~~ U pra~r~ ~ `v ~ `o 'f•~ ~ X gRF~+SL' L: ~(QraP ~ ~ ~ u ~ ~ ~ ~ v -~2L~~~-~ ~C~~, ~S~D~i'~.`~-`~ ~7.~ . Z~ auk . ' ' 80~1R0 OF HEflLTH , ' 0 SETS OF PL.1NS , • •Y, • ~ ~ • FORM N0. 1 SURVEY • o o s o ' ° ° • ° • o 0 TOWN OFSOUTNOLD C1IECJC •a` - BUILDING DEPARTMENT ~ ° ' ° ° • • • • • . SEPTIC FORD! . TOWN HALL • SOUTHOLII-tu.Y-1'lff7l P;ATIFY; TEL.:7G5.1II02 CALL ,,~~p,~„~'~S,j•"(,• Exantincd f,Y~"'~„ !i„x.19 ~l~ MAIL TO : • ~ • • • ~ • Approved j:s "l~Y.~Pctinit No. _ . _ Disapproved a/c'...... ~ . r.. o' ,.'1~~ ~ ~[Tuildyti~nspcctor) • • • ~ ~ APPLICATION FOR BUILDING PERMIT ~ • v •~T O'~i~' ,fib.'..: I991 • INSTRUCTIONS a. Tltis application must be eompletcly filled in by typewriter or in ink and submitted to the BuildinE Ins , sets of pL•trts, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of building pector. urttl or areas, and giving a detailed description of layout of propertyemust beedrawn otn theadiagram whichiss or publicstrc: cation. parz of this aPF c. The work covered by this application may not be commenced before issuance of Building Pe>•tttit. zl. Upon approval of this application, the Building Ins ector=tvill~issucd a Buildih~ Pcctnit to the a shall be kept on the premises available r inspection throughout Phe work. Pphcant. Such pert. e. No building shall be occupied used in whole or in part for any purpose whatever until a Certificate of Occupy;; s all have;been granted~¢yryhe Building pector. APPLICATION~ISsHirI2' BY MA 1~ .the Building De~e~t f~,.. r e issuance of a Building Pe.-mit pursuant to tl Building Zone Ordnance ofy the Town outhold, Suffolk kegulatioris,:.fsxi the tonstrtictl~in of b ~ other applicable Laws, Ordinances c The a lice s, additions or a PP ~t{,~ ~~°i£41 ooFnply with all a lica<ile laws, ort~3~g,~lgd~• ~OVaI or demolition, as herein describes tdmit authonze~mspectots on premises and building for nec~ssaryk d~>P~ housing code, and rc~ ~ ou bons, and t - _ . ' ~ re of applicant, or name, if a •corporatton)' ' ` 29 Ha1f,Fjo•llow Road Cix H211s Newyork 11746 (Mailing address of applicant) • ~a~aasl~>~rnanaa~,r~~ Mate whether applicant is owner, lessee, agent, 'archj~g~~,`'e~~„~'ne~rt"R • te"r~i~cont . . . OWNER~6~I~~~ • MIDD' ` ` "•~"'"'~r' electrician, plumber or builder LE ROAD SHOPPING•CENTER. INC. 'ame of owner of premises ~ • • • • • • • • • ~ - • - ° • • • • t`IAIC-~ O9NSTRUCT'I4~s .INC, ~~eest deed} " " • applicant is a corporation, signature of duly au ' AUC,iTSTO MAT,ANpRUO0OLO Pres. a ~ ' Name and title oP corpora'tc ofCccr) ~ Huildcr's' Liccnsc No. ,.,1b,~~, . _ - • - • • T~ ~14''~$1~1~R43 . ' - Plumber's Liccnsc No. .49,1,-J; , , • , , • 4" ccfnctan's Liccnsc No. L4,4,1,-•E, r . ~ „ . , Olhcr Trade's Liccnsc No. , , , , , , ' Location of land on which proposed work will be done; 55 C: R. 48 MATTITUCK NEW YORK 55,County•Road•48 ....,Mattituck 1louse Number • • • • StrceL HatnlcP ~ • • • :ounty Tax s\lap No. f 000 Section ,1, ;1, Block .,,2 . tsion • • • • • •.F,ilcd Ala {s No L (N:unc) t tztc existing use and occupancy of premises and intended use and accu • • • • • • • • • " Lot • PancY of proposed construction: fl• Existing use and occupancy. ..HO.K~ ' B., Intended use and occupancy. ; , . , ...:PJ.?''z~ , ~Td{j~~ t • p....r~x.. r ..:..o,......,.. i t ~ mf•M « Mm , r ~ i 1 ~ ~ . o ~ dl~ 3. Nstura of work (check which a Tennis. Court , pplicable):.Nevi,DuiWing , Addition' ~ • ~ ~ • • ~Utcration Tn~griox . Rc air• R• p prrioval Demolition .....Swimming Pool. • • . Accessory Building.:........ Fence .Othcr• Work: •X,•,•,•,•,•,•, e.. ..n. F,~.,~. ._,~wh-,~ W .....:....A.•....•",r.: ,may-s...:=•.,r'„~ 4. EstitnatcdCost...$1 Q0.(1.Oi1.,........... Fee • ' ~ ' ~tn-bc aid on filing~hisatiplication~ 5. If da•cllin;, number of dwcllin; units , N~A, , , ; , , ; , Ntlmbcr of dwelling units on each floor . If garacc, number of cars NSA, , , , , " " " " 6. if business, commercial or mixgfd occupancy, specify nat~u're•and extcnt•of eaGlt•typc•of use b.. ~3.$TQ~E, , • • • • 7, Dimensions of existing structur'cs, if any:' Frone ..$0.......... , Rcar ~ Depth • . (Q„ , , , H~i~ht rox. • • • dRR..,, Nu' ' , ntbcr of Stories ....1 Dimensions of same structure with alterations or additions: Front Z0, .Rcar ~ z°, Depth .......6Q.:........'',.. Height... :1Q:.. . . Nurttbcr oC Stories . ,l • • • • • . 8, uncnsions of eritirc new const u ntction: Front ..N/,A....:::.'::,:Rcar'...,::.,.:...:: • Depth Hu_Itt , • : • - tuber of Stories • • • • 9. Size of lot: t ..176 ~ Rcar . 0. DatcofPgri; `larch• ~3.,..1J$9•.. • ....261 _ Depth ...~92 ~ Name of Former O~}t~~le Road ,A~~o,~i,at,~,s, , , , 1. Zone or use district in which,PSemiscs are•situated f Light Business _ • 2 Does proposed construction viglate any zoning taw, ordinance or regulation: . N.O, , • • • . • • • • • • • 3. Will lot be regra.lr.t Nn ~ Jut excess fit( be removed from prcmises:• • ~Ycs X . IVQ q, Name of Owner o zcm ~ 1 _'vltcl]le l~ixl Cstte~,~ 2g i~alf•Fbll~a 1 986 f p ices 8 ~ NY T174 Name of Architect , , , , , , Ad ress . ls:........ Phone No, 5 Cr56 • • , : , , , . • Name of Contractor .:131t~.~~icrtt ,Inc; • • , , , ,Address . ~ .Phone No... ~ . l5_ls this propertp 1oc~ted within 300 feet of a tidal wetland?•*Y):5.,..Np,X.. *If yes, Southold Tovln TrusCCes Permit may b,e required. • PLOT DIACRA\i Locate clearly and distinctly a~l buildings, whether existing or proposed; and.indicate~all set-back dimensio^: t: roperty lines. Give street and block number or description according to deed d show street names and irldicatc }t::e4i. uerior or comer lot. • ~ ~ ~ ~ ~ ~ E ~1 ly v 1 ~ ,1 , . CY QR , . , ; .,USE IS.U~lAW4~U'l . ~ ' ~ ~!M>~ ~ ~ ~ WI~Ht~~UT CE:I~~fFN'~ATE OF~~OCCUPANCY~~ v at~ei ~y,~ern d~nj^s ~ ~~t,~~, r ,.P ~ ~,._,.,wAPP'R W~irASNOTED ~ ~ DATE: ~ ~ ~ B.P, # ~J t..dit•~~_ • , ` g1~QV~11A1~ NOTIFY BUILDING OEPA(tTMEN7 A7 ~y~JpTE1~UNftSN~ED r 786,1802 8 AM TO 4 pivl FC1R YHE FCILk't)WII~ta,INSPECTIUNS: T~E$'N,lwtd BEFOf~tfi}G'i^:IWFrRtNt4 y • I ,•T ` , r" t~~: ' r~~,FOp P UFi~DCON RETEEClUIRED . r ~ 4 z"'" Z' Ri~UOakf 11,3AMING'Rr PLUMQ~~NG ' a • ~ ~ ' ; .i' ~ u"~ia r« e`t `,'~1'" : "~"et1i1~U14AT1t)N ~ ~ < ~ EI 1 r k~'~ ~tt~ rsc' 1i)*~ aAK a + 4:, FINAL CONSTRtI~j'tON MUST _ ~4,1!~.~ ~ ~ ~,E~at~lP~'r~ FpR c~a k QN~nr +i' 1 ALL`° QN,~p~'RUCTION ,MALL M~~T~~ • CERX ~ Elf THE ° R~(k~tNR~tytEN"I`S~ '~~,5 ~`C~M@ t' {W V x` P , ~ w , 8'4~T~'1~'f~ ~~RGG'C10N's;~ ~FEFJ6R`~7Y , ' ~~~PPI~Y~'Y11t~AA'~ , D~s~Gi~ pr,~'O~NSrnuc'~r~~~~s~~ i~:l~~ r;,; TA7E OP NEW YORE, ~ 5.S ~ ~ ~ ~ OUNTY .OF SUEk'4I~K . _ ' AUGUS~O ,1NAL]t:I~I)l2v~COLO'.,', • - • . being duly sworn, deposes and says that ha is the applita:- • (Name ofindrvidual si;hing con [ract) ~ovc named. ' . • . r is the Pr?-.~~.41~n.*-.... r, . •~i. ,...r •i Contractor, agent, corporate officer, etc.) ~ ~ ~ ~ ~ ~ ~ ~ f said orJncr or owners, and is duly authorized to perform or have performed the said work and to msl:c and file tl: tplication; that all statements conkained in this application arc true to the best of his knowledge and belief; and that a_ ork will be perfomtcd in the manner sut forth in thu application filed thcrewitlt. wom to before me this „ . ......day d;f . Jfznuary ;19 ' • ~ otary Public. ~Q,t.~°~ - . , ,u1•< County . , • F,~IAtNE SUSCHINO ~ . ~ ~ ~ ' . Notary` ublic, State of Nowpy~ r ~1tiRC:ltNCi - /Qy~~~~~ N4. 6Y•47~8ti41 : ~t/C' e'nW >•f rt~G.L / • ~i 4 I . i ~ , • ~ ~ 1 ~ • . CommlwlOn~lOSafl01k-1.la,•~ ...rnl4~erullLL.a::li:`r~, ; ~ ~ (SlonaLllrCOf apptlC3n ExpireaJUty91,1 „„4c.c f; J1.13 _ t m~ ~"a'4~13~Y! /f ~i ~ ~ ff1 1~~ / ( Mo~.~ ~ _ 1 ~ ~ C 4,~~~~_ ~ U Q UC.~~`~`;~f. 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N,-a'c" I L~-ii' -c,'/"'~' r., .ti i ~ ~ vl i{ ~ I w - i; f ~ ~ a~ 4 ~i ~ I Y c~I i ~ 2 ~ ~5 ~ ;I r! H- ~ i I { 'i' - - it i ~ ~ ~ I I- v. _ I ~ o v, ~ I ~ ~(1 ~ _ ~?~j f ~ _ D I i ~ ~o W I - ~ - 2 ~ L .-x. ~1 . i r