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Home My WebLink About21286-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22225 Date MARCH 26r 1993 THIS CERTIFIES that the building ALTERATION Location of Property 10095 (23) MAIN ROAD MATTITUCKr N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 142 Block 1 Lot 26 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 9~ 1993 pursuant to which Building Permit No. 21286-Z dated MARCH 25~ 1993 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 #23 FOR MENS CLOTHING STORE "AS BUILT" The certificate is issued to ALAN CARDIN~LE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-010075-4/25/88 & N-113112-2/7/90 N/A · Building I-~spector Rev. 1/81 FOuM NO. · TOWN OF SOU'Fi'tOLD BUILDING D£PARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERAAIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2128SZ pursuant to application dated .......... ..~..~ .......... ~ ........... , 19...~.'.~, and approved by the Building Inspector. Rev. 6/30/80 · A. Form No. 6 TOWN OF souTHoLD BUILDING DEPARTMENT TOWN HALL 765-t802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be fiAled 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 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. 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, buildimg 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 i. 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 Date .... .~. · .~/~. · ~..~ .~ .~ .~.' ~~~ .............. New Construction ........... Old Or Pre-existing ~uilding ................. Location of Property..~-~~~.~...~~ ~g~.~..~.. ~.~'~...~~..~... ...... House No. Street Hamlet 0nwer or Owners of Property .... ~ ............................... County Tax Map No 1000, Section../.~..~. ...... Block .... ~ .......... Lot .... ~. .............. Subdivision .................................... Filed Map ............ Lot ...................... Permit Xo.~./. ~..~.~....~--..Date Of permit~/.~...~-./.~.3..Applicant...~~ ............... Health Dept. Approval ......... ......... ' ....... Underwriters Approval....'.~. ~./../3./../...~... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate....~/.. ..... Fee Submitted: ~.--.~. ~ ~ ~ ........... C 0 ~.~ ~(~C9oq APPLICANT THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date /Ippllcatlon No. on file THIS CERTIFIES THAT ....... a. ....... licatlon number in the premises of only the electrical equipment as described below and introduced by tt~e opp~canr namea on~ rne aoow ut,t, in the followlng location: ined on FIXTURE OUTLETS DRYERS SERVIC~ DISCONNECT OTHER APPARATUS: ~ Btrsement ~ L~t FI. ~ 2nd FI. Section Block Lot and found to be in compliance u. ith the requirement.~ qf this Board. SWITCHES FIXTURES ~ ~ECKS OVENS DISH WASHERS [ ' ' *S ' E R v I c '~'HAUST DIMMERS GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MU HO BE ALTERED IH ANY MANNER. ~TURES FIXTURE IECEPTACLES SWITCHES INCANDESCENT FLUORESCENT I OTHER OUTLETS ~,ULTI.OUTLET DIMMERS DRYERS ~, FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R__ -- CC. COND A.W G, V I C E NO. OF HI-LEG NO. OF NEUTRALS OTHER APPARATUS: Gmr~.~ This certificate must not be altered in any manner; return to the office of the Board if incorrect, ~nspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THRS COPY OF CERTIFICATE MUST HOT BE ALTERED IN ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD · BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Examined ................ , 19... Approved '~. 4..~..., 19'.~ff7. Permit No. ~ ./...,'~...~/ Disapproved a/c . ...' ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT BOA'RD OF HEALTH 3 SETS OF PL.INS SURVEY ................... CIIECK .................... SEPTIC FORH .............. I':OT I PY ~ CALL HA I L TO: INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of tot 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- cation. c. 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 shall 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 shall 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. 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 for necessary inspections. - (Signature of applicant, or name, if a corporation) 2. 2,..;. .. ,,.. .' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .C- ~ Z..c:?q...¢~ .' .............. , .............................. Name of owner of premises. '~q-5/....ffT'.~..:...~..<~T.p~/~z~-d_~ ..... : ............................... 7'' (as on the taX roll or latest deed) If applicant is a Corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Pluznber's License No. Electrician's License No..~.~-~_~.....~..~.~..q~.'.': Other Trade's License No ...................... Location of land on which proposed work will be'done. ,,~..~...._~.~.. ~ .~.~.~7 House Number Street c, i~i~;l'l;; ........................ County Tax Map No. 1000 Section / 4°Ox Block / ' Lot ~ ~. Subdivision ..................................... Filed Map No. (Name) .............. Lot ............... State existing use and occupancy off. raises and intended use and occupancy of proposed construction: a. Existing use and occupancy...,~..~...'.~. ............ b. Intendeduseandoccupancy . .~....~...O~...~ ....................................................... 3. Nature of work (check which applicable): New Building. ' Addition Alteration Repair .............. Removal .............. Demolition .... .' ......... Other Work ............... ~...~.~ ~ ~/ .' ' · (Description) 4. Estimated Cost / .~..~...~, ~ '''"''-'. ....... .....-.-...... Fee ........ . ...... .-.-..... ......... .-... 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 extent of each type of use .~.'~x~f.~c~.~. 7. Dimensions of existing structures, if any: Front ............. Rear ... ........... Depth .. ~f..i .... Height ............... ~umber of Stories ........................................................ Dimensions of same structur,, with alterations or additions: Front ................. Rear .................. Depth ..... ' ................. Height ........ ' .... · ......... '..'Number of Stories ........... '...' ....... 8. Dimensions of entire new construction: Front ............... ' Rear ............... Depth .............. Height ............... Number of Stories ............................................. - .......... 9. S~ze,~flot: Front .......... . ............ Rear ...................... Depth I0. Date of Purchase ...................... .................... ......... Ncr~ae of ~Former Owla~ ........ ; ............. . ....... I1. Zone or use district in which premises are situated ,/~?f~_,~..,~_~_a_~.i.7,/'j/~'v... ~?.~_'~ 12. Does proposed construction violate any zoning law, ordinance or regUlatio~n:' ' ...... 13. Will lot be regraded ...... ' ................................ · .'-~- ........-,~ ........ Will excess fill be rem,o..~ed from premises· Yes No 14. Name of Owner of premises ~24~..~. ~6gz~:.,f~ddress 2~z~ ~fc.-,? ~ ,,~ . '..~ ~,- ..... ......... ·" .'. · .z': ·, -' ...... rhone v4o.~.~/.~.-,~ Name of Architect ........................... Address ........... ........ Phone No ............ ;... Name of Contractor .......................... Address ............. Phone No . · . 15, ' Is this property within 300 feet of a tidal wetland* ~Yes ..... [~ ~'~3'~ ............. ~ *If yes, Southold Town Trustees Permit may be'requir~'''~' ,~o .... ~r.... ---. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& 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 comer lot. 3TATE OF NEW YORK, ~ ~ :OUN'rY OF. .F/ Lc.K. ..... . .............................. being duly sworn, deposes and says that he is the applicant ( of individual signino contract) bore named· Ie is the ...................................................................... . .................. (Contractor, agent, corporate officer, 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 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· worn to before me this ....... 1.0 ............. dayof. ......... , · ' .' .,4'1./. / . Notary Public, Suffolk . ] . ..~5.. ff~....'(./...~...a.~..~; ~ C ~u{nty, NY ,"/01 FA4991777/ /' ............ : ................ ommission Exp, 2-10-9 '~ (S~gnature of applicant)