The URL can be used to link to this page

Home My WebLink About20848-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21000 Date SEPTEMBER 10~ 1992 THIS CERTIFIES that the building ALTERATION Location of Property 10095 MAIN ROAD (STORE 1E) House No. Street County Tax Map No. 1000 Section 142 Block 1 Subdivision Filed Map No. MATTITUCK~ N.Y. Hamlet Lot 26 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 15, 1992 pursuant to which Building Permit No. 20848-Z dated JULY 28~ 1992 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 1E FOR A GAMEROOM The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED PENDING - SEPTEMBER 4~ 1992 Rev. 1/81 FOKM NO, ~ 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) NO-No. 20848Z Permission is hereby granted to: ..... ~..~.~..~.~;...~~...~.~,~~,~ ~.~ ~ ~_~ ........ at premisesJo~t~ at ..... ~...~ ............ '~ ~ ~ ..... , ...... ~/..~...J~ ....... ~_~..,. ........ /.~.~.~...~.~.~..~...4~.~~ .................. ~ County Tax Map No. 1000 Section ...Z....~..R~ ...... Block ....... l ............. Lot No ....... ~..~.. ...... pursuant to application dated .................................. ....,,~. /~.. , 19.~.....,~nd approved by the Building Inspector. ~--/ ~" Fee $... Z .~.ff.,....~....~ Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~ ~LL ': 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-disposal(S-9 form). 3.Approval of electrical installation f~om 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 Vpre-existing" land uses: i. .Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and'~ 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. 2. 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 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 ,ew Construction ........ ' .......... Or ~re-existing~Bui~ing .................. .... ouse No. '" · nwer or Owners of Property ounty Tax Map No 1000, Section.../.~.~ ..... Block ....... i ........ Lot ..... ~.~. ............ ubdiviaion ' ' ................. '; .... : ........ Filed Map.. Lot ermit No ...... Da Of Permit ................ Applicant ........ : ................... ~alth Dept. Approval ................ .......... Underwriters Approval ........... lanning Board Approval ........................ ~quest for: Temporary Certificate ........... Final Certicate ........... Submitted: ................... ~_~ ~ ~ ~ . . ' APPLICANT THE NEW YORK BOARD OF FIRE UNDERWRITERS [ I ~, ~ 6 '~ BUREAU OF ELECTRICITY r~ 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date ['~ ~ i~ ~]~ ~ H ~. ;~ ~[ ~ ",~ ~ .1 ~j~ g ~ ~ppllcatlonNo. onfile ~ ~ ~' ~ (~ ~ ~/' ~ ~ ~ THIS CERTIFIES THAT o~iy the ei~tricai ~uipment ~ ~scrlb~ be~w and int~uced by the applicant ~med on the a~ve application number in the premises of u~s examined on ~ ~ ? ~?~{~ ~ ~4,1992 and found to be in compliance u'ith the req~tirements qf this Board. F XTURE J [ ~ FIXTURES RANGES C~KINGDECKS OVENS DISH WASHERS EXHAUST FANS ~T~TS ~ 'ECEPTACLESl SWHCHES JlNCANDESCENT I FLU~ESCENT OTHER [ ~T. KW AMI K.W [ ~T j KW [~T ~ KW. [ ~T. ~ HP DRYERS ~RNACE MOTORS ~TUR, A~IANC, .,.RS SPECIAL REC'PT~ TIME CLOCKS [ Sift J UNI, HEATERS M~[.T DIMMERS ~T. K.W. OIL H.P. GAS H. P ~l NO A, W. O I AMT ~P. j ~T A~PS TRANS. AMT H. P NO. OF ~ET AMT. WATTS - SERVICE DISCONNECT NO. OF , ~ / METER A~T. AMP TYPE { EQUIP. OTHER APPARATUS: S E R V I C E OF CC. COND AWG. OF NEUTRAL LIDG:, NY, llq6l GENERAL MANAGEII 1 1 Per ' ' This certificate must not be altered in any manner; return to the off;ce of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ?OU:;DA~IO.~; ( 1 s t) %OU~DATIO:! ( 2nd ) IOUGH FRAME -PLUMBING ]. i~/SULATIOf! PER N. Y. STATE ENERGY CODE FI;!AL ii ZL.',2i. ~-. 7?. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ................. 19... ,,pprove _ .... I9 f Permit No..2,.. z Disappr~'ved ,4/c ................................. SURVEY ................... cu~cK ~ .................. SEPTIC FOR,"{ CALL ................... HAIL TO: __ (Building Inspector) APPLICATION FOR BUILDING PERMIT DateO--~7- 'S- INSTRUCTIONS a. 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ¢. The work covered by this application may not be commenced 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 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 or alterations, or for removal or demolition, as herein described. 1-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. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.· .~ame of owner of premises ~.C.~..M...A: .C..~te. o/..~/.g[tr. ~.....~t~ ..... .~.~6. (as on the tax roll or latest deed) If applicantfi~ a corju~-at4on, signature of duly authorized officer ' .t-- .... ~ t and title Of corporate officer) Builder's License No. ' Plumber's License No ......................... Electrician's License/X/o..~'~-~... ! ~..~. ~...~.---.'... Other Trade's License No ...................... Location of land on which proposed work will be' done. ]X~ A'T-'~ ............ I..°.°--~7..: .... ~nt~.. ~-~. ~'n.~.~..~.../~..,f.. ilouse Number Streei ........... Hamlet .................. CountyTa.~MaoNo. 1000S~ction ..!.?~ ........... Block 'l .................. Lot....?,.6 ........... Snbdivision ..................................... Filed Map No. (Name) .............. Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occunancv ~ O/,tq/~/~_c/~C ,. . b. Intended use and occupancy /'ad 0.,~. ', 3. Nature of work (gheck ~,hich applicable): New Building .......... Addition .......... Alteration .......... Repuir .............. Removal .......... Demolition Other Work ~/,5'C) ~ ' ' 5 (Description) 4. Estimated Cost ...................................... Fee .. .~t~. ~ .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 can 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 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 n~w construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories 9. Size of lot: Front ..... ~ ....... ' .............................. ] .......... 10. Date of Purchase ....................... Rear ............... ' Depth ......... ............... : .... ' ......... Name of Former Owner ............................. 1 I. 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 Name of Architect .................... Address ................... Phone No. Name of Contractor' .......................... Address ................... Phone No ................ .......................... Address ................... Phone No .... 15. Is this property within 300 feet of a tidal wetland* *v~ u~ ' ........... ·If yes, Southold Town 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 number or description according to deed, and show street names and indicate whether interior or coruer lot. ~'OUNTY OF~ .}.. ~ .~. t.%.. ..... ~..~. '.~::.~.'L lk_..~..', j .'~.[..~..i?.~/.{.Q.~, ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bore named. f said owner or owners, and is duly authorized to perform or have performed'the ;aid work and to make and file this 9plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. wum to before me this ........... · ,,