HomeMy WebLinkAbout29217-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30134 Date: 04/15/04
THIS CERTIFIES that the building ALTERATION
Location of Property: 61600 MAIN RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 56 Block 6 Lot 3.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 6, 2002 pursuant to which
Building Permit No. 29217-Z dated MARCH 13, 2003
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 TWELVE MOTEL UNITS IN AN EXISTING MOTEL AS APPLIED FOR.
The certificate is issued to C & L REALTY INC
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1173787 03/04/04
PLUMBERS CERTIFICATION DATED 03/23/04 DINIZIO PLUMBING
uthorized Signature
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 29217 Z Date MARCH 13 , 2003
Permission is hereby granted to:
C & L REALTY INC
MAIN ROAD
SOUTHOLD,NY 11971
for
ALTERATION TO TWELEVE TRANSIENT MOTEL UNITS AS APPLIED FOR WITH
FLOOD PERMIT
at premises located at 61600 MAIN RD SOUTHOLD
County Tax Map No. 473889 Section 056 Block 0006 Lot No. 003 . 004
pursuant to application dated DECEMBER 6, 2002 and approved by the
Building Inspector to expire on SEPTEMBER 13 , 2004 .
Fee $ 1, 384 . 10
Auth rized Signature
ORIGINAL
Rev. 5/8/02
Form No.6 2 m
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 Department with the following:
A. 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.
B. 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 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 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- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00
Date. -30 I
New Construction: Old or Pre-existing Building: \/ (check one)
Location of Property: U 1 (1 00 Igi l J !c-CL -S(7 t t,fine Lir�s
House No. i/ Street Hamlet
Owner or Owners of Property: ac: i- l�tl (�I a wi �.- ('�`-�rl
1473889.
Suffolk County Tax Map No 1000, Section . Block (y Lot 3
Subdivision Filed Map. Lot:
Permit No. �Q oZ 7 Date of Permit. 3 (3 Applicant: [',,} �. R�eu.e
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: VI" (check one)
Fee Submitted: $ 50, 00
3o 1 '
(�� �- Appli f Signature
S BY THIS CERTIFICATE OF COMPLIANCE THE
5 NEW YORK BOARD OF FIRE UNDERWRITERS
5
SBUREAU OF ELECTRICITY
5 40 FULTON STREET -- NEW YORK, NY 10038
5 CERTIFIES THAT
5
5 Upon the application of upon premises owned by
5
�j JIM SAGE ELEC. INC. *TURNING PT MOTEL
CS'J P.O. BOX 38 RT 25
5 GREENPORT, NY 11944-0038, SOUTHOLD, NY 11971
SLocated at RT 2.5 SOUTHOLD, NY 11971
5
Application Number: 1173787 Certificate Number. 1173787
SSection: Block: Lot: Building Permit: BDC: 111
S
Described as a Commercial occupancy,wherein the premises electrical system consisting of
5 electrical devices and wiring,described below, located in/on the premises at:
SFirst Floor,Second Floor,Outside,
5
5 was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was
found to be in compliance therewith on the 4th Day of March,2004.
5 Name QTY Rate Rating Circuit Type
Miscellaneous
total renovation of motel
5 rooms 1 through 12
including outside
5 Alarm and Emergency Equipment
Sensor 12 0 Carbon Monoxide
Appliances and Accessories
Dish Washer 12 0 1.2 KW
5 Furnace 12 0 Gas
5 Air Conditioner 12 0 18.000 BTU
5 Panels
12 60 10
SWiring and Devices
SReceptacle 228 0 General Purpose
5 Switch 168 0 General Purpose.
5 Fixture 120 0 Incandescent
Cj Disconnect 12 0 60 amp Air Conditioner seal
C5� Receptacle 30 0 GFCI
5 1 of 1
5 This certificate may not be altered in anyway and is validated only by the presence of a raised seal at the location indicated.
5
v
o�S11FF0L/cCA
�O
Town Hall,53095 Main Road
Fax(631)765-9502
P.O. Box 1179 Gy O�'�` Telephone(631) 7654802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date:
Building Permit No. �(�a 1-7 q
Owner:
(Please print)
Plumber: 01 nk i, ol►w
Ple se prin
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
( in ers Signature)
Sworn to before me this
day of k%Sk , 20_g_4_
W �
Notary Public, County
BONNIE!.DONM
Notary Pabik,Sub Of NeNTA
No.OID06095328.S"=
Tena Exp mj*1031
Garrett A. Strang
Architect
1230 Traveler St., Box 1412
Southold, New York 11971
April 22, 2004 Telephone (631) 765-5455
,R 2 2 260 Fax(631) 765-5490
Mr. Mike Verity
Southold Town Building Department
Main Road
Southold, NY 11971
Re: Terning Point Inn, Main Road, Southold, NY
Dear Mr. Verity:
Please amend the permit in the above referenced project to include twelve (12)units, in lieu of six(6)
shown on the drawings.
Also, the above does not constitute a significant improvement, rather maintenance.
Very truly yours,
Garrett A. Strang, R.A.
Architect
BUILDING PERMIT EXAMINER CHECK LIST
_ DATE REVIEWED: -P /3 /03
APPLICANT: L - lrwi Co%gr IWa Omrs W DATE SUBMITTED: JZ /_,610x
SCTM#
DISTRICT: 1,000, SECTION: 56 BLOCK: b , LOT: 3,4 SUBDIVISION: Flo
ADDRESS: ,6i&c,p titer 'Ra , CITY: 6pAA,-,akJ ZONING DISTRICT:RZ _CONFORMING? '163
BUILDING PERMITS OPEN/EXPIRED:
BPO-1503 -Z/ C/0 Z-X845(., INFO 12aoc Ac.-r /BP '1-'1159 -Z/C/0 Z- 5354 , INFO
BP 40 1 Z/C/0 Z- 5355 , INFO — _/B - - I C70 Z-�(P INFO ice.,
P - BP 12z�j -Z/ C/0 Z- 1L1!j 9 6ST SP5�Mll-
JL
,z 535.
SINGLE & SEPARATE CERTIFICATION-REQUIRED No NOTES:
LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/82
REQ. LOT SIZE:pax2ACT. LOTSIZE: 2p REQ. LOT COV. SACT. LOT COV. y
REQ. FRONT 35 PROP. FRONT REQ SIDE aobb ACT. SIDE
REQ. REAR oAi� PROP. REAR i REQ. HEIGHT —PROP. HEIGHT
PROJECT DESCRIPTION: ((,)
ESTIMATED PROJECT COST: 2b'{L /ENGINEER: FAST TRACK LiQ
WATER FRONT? 4E� DESCRIPTION: tucM 'PcND
PANEL #: i ci FLOOD ZONE: 4F 8 , COMPLIANCE: iJA
�T APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH DOT: YES o�, (BED #): DTE: /_/ PERMIT#:
TOWN SEPTIC RECEIPT: Y or
NEW YORK STATE DEC: PRE-D C 9/1/75 YES or
SOUTHOLD TOWN TRUSTEES: YES or
TOWN ZONING BOARD APPROVAL: YES or
TOWN PLAN. BOARD APPROVAL: YES or
TOWN HISTORICAL PRE (SPLIA): YES or
NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2): YES or NO
NOTES: # '
O
FEE STRUCTURE: FOUNDAON: _ SF U9M '7.ysq�p, v UNIT IZ
FIRST FLOO SF y S9,c S = oZ� 5,12
SECOND FLOOR: SF g' " •�� -�tt[�+L,.
OTHER: SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
to
1. c �0� SF)- ��� SF)= SF X $ _$ 2 +$ +$ _ $ 4jr
FAD P2m
2. ( SF)- (_ SF)= SFX $ _$ +$ +$/a0 = $ O0
/o
3. (— SF)- L SF)= SF X $ =$ +$ +$ = $ 2-
FINAL
FINAL TOTAL: $
NEW YORK STATE CODE COMPLIANCE CHECKLIST
USE/OCCUPANCY CLASSIFICATION:
HEIGHT/FIRE AREA:
TYPE OF CONSTRUCTION:
DESIGN CRITERIA: ENGINEERED/PRESCRIPTIVE
FULL FRAMING DESIGN ELEMENTS:
HEADERS: Y/N WALL STUDS: Y/N
GIRDERS: Y/N CEILING JOISTS: Y/N
FLOOR JOISTS: Y/N ROOF RAFTERS: Y/N
LUMBER SPECIES AND GRADE: Y/N
DESIGN LOAD CALCULATIONS: Y/N
SHOULD INCLUDE LIVE,DEAD,SNOW,SEISMIC AND WIND(INCLUDING UPLIFT AND EXPOSURE)
WINDOW AND DOOR SCHEDULE:
MISSLE TEST REQUIREMENTS: Y/N a(7170 L 1667. W "
EGRESS, LIGHT, VENT: Y/N
-LOAD PATHS: Y/N
ROOF TO FOUNDATION
NAILING/CONSTRUCTION SCHEDULE: Y/N
MEANS OF EGRESS: Y/N
PLUMBING RISER DIAGRAM: Y/N
LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N
TRUSS DESIGN: Y/N
CERTIFICATION: Y/N
ENERGY CALCS: Y/N
TOTAL COMPLIENCE? Y/N(RETURN TO PAGE ONE)
4EDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 1-
ELEVATION CERTIFICATE
Important Read the instructions on pages 1-7.
r SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
C&L Realty, Inc.
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
61980 Main Road
CITY STATE ZIP CODE
Southold, NY 11971
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
1000-56-06-6.1
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
Nan-residential / Motel
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-W-##.##" or ##- ) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
Town of Southold 360813 SUFFOLK NEW YORK
B4.MAP AND PANEL B5.SUFFIX B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding)
36103CO159 G 05/04/98 AE EL.8
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 89.
❑FIS Profile ®FIRM ❑Community Determined ❑Other(Describe):
B11.Indicate the elevation datum used for the BFE in B9:®NGVD 1929 ❑NAVD 1988 ❑Other(Describe):
B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)?❑Yes ®No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Constriction Drawings' ❑Building Under Construction' ®Finished Constriction
'A new Elevation Certificate will be required when constriction of the building is complete.
C2.Building Diagram Number 1(Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,ARAE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3.-a4 below according to the building diagram specified in Item C2.State the datum used.If the datum is different from the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G,as appropriate,to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on theFI ? ❑Yes ®Pb
o a)Top of bottom floor(including basement or enclosure) 6. 7 ft.(m)
o b)Top of next higher floor _ —ft.(m)
o c)Bottom of lowest horizontal structural member(V zones only)
o d)Attached garage(top of slab) w
+` l
o e)Lowest elevation of machinery ardor equipment
servicing the building(Describe in a Comments area) 6.7 fL(m) E 1i
,/ a
o f)Lowest adjacent(finished)grade(LAG) 5.1 ft-(m) z' ° _ �'• � �4 d(
o g)Highest adjacent(finished)grade(HAG) 5. 3 ft.(m) "� 'r F,I I�
o h permanentNo.of '
openings(flood vents)within 1 ft.above adjacent grade (7J
o i)Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
1 certify that the information in Sections A,B,and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U S Code Section 1001
CERTIFIERS NAME JOHN T.METZGER LICENSE NUMBER 49618
TITLEPRESIDENT COMPANY NAME PECONIC SURVEYORS,P.C.
ADDRESS CITY STATE ZIP CODE
P.O.BOX 909 SOUTHOLD NY 11971
SIGNATURE DATE TELEPHONE
09/04/2003 (631)765-5020
IMPORTANT: in these spaces,copy the corresponding infomudon from Section A For Inman ce Company Use:
BUILDING STREET ADDRESS(Inducing Apt,Unnit Suite,ardor Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number
CITY STATE ZIP CODE Compary NAIC Number
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agert/company,and(3)building owner.
COMMENTS
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(Without BFE),complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be completed.
E1.Building Diagram Number_(Select the building diagram most sim1arto the building forwhich this certificate is being completed–see pages 6 and 7. If no diagram accurately
represents the building,provide a sketch or phobogaph.)
E2.The top of the bottom floor(including basement or enclosure)of the building is_ft(m)_h.(cm)❑above or ❑below(check one)the highest adjacent grade. (Use
natural grade,I available).
E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the bw'Iding is _t(m)_in.(cn)above the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the platform of machinery ardor equipment servicing the building is_ft.(m)_in.(cm)❑above or ❑below(died one)the highest adjacent grade. (Use
natural grade,if available).
E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the commur ly's floodplain management ad dance?
❑Yes ❑No ❑Unknown. The tical ofliaal must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The properly owner or owner's authorized representative who completes Sections A,B,C plains C3.h and C3.i only),and E for Zone A(wiftut a FEMA-issued or community-
issued BFE)or Zone AO must sign here. The statements in Sekdions A,B,C,and E are corned to the best of my knodwe e,
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the eomrwnity's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate. Camplede the applicable ttem(s)and sign below.
GL❑The information in Section C was taken from ollwdocumentation that has been signed and embossed by a licensed surveyor,engirm,orar hitectwho is attiorized bystate
or local law to certify elevation information. (Indicate the source and dace of the elevation data in the Comments area below.)
G2.❑A community dkial completed Section E for a building located in Zone A(without a FEMA4ssued or corvrwnitlrissued BFE)or Zone A0.
G3.❑The following information(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERnF &TE OF COMPLiANCB=UPANCY ISSUED
G7.This pemtit has been issued for[]New Consinxtio►n ❑Substantial Improvement
G8.Elevation of asbA lowest floor(including basement)of the building is: —_1t(m) Datum:
G9.BFE or(in Zone AO)depth of flooding at the building site is: —_ft(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
o�$u�Fot,�oo
Gyp
N
Town Hall,53095 Main Road v, Fax(631)765-9502
P.O.Box 1179 , Telephone(631)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Fire Inspection Report 2004
April 1, 2004
Mr. William Leiblien
Heron Harbor Suites
62300 Main Road
Southold, NY 11971
Dear Mr. Leiblien:
Thank you for the cooperation during the fire inspection of Heron Harbor Suites on
March 23, 2004.
New and existing buildings shall have building numbers placed in a position to be
plainly legible from the street or road fronting the property. The numbers shall be a
minimum of 4 inches high. Your building number is 61600.
During the inspection the following violations were noted and should be corrected
immediately.
Missing red emergency switch plates are missing in units 1 and 5.
The insulation in unit 13 (utility room) shall be properly covered as the space is a
conditioned space. The space shall meet applicable codes for construction and use.
Gas services that are exposed"shall be protected. This pertains to the gas services on
the parking lot side. %..
Fire extinguishers shall meet the following requirements.
1. A minimum rating outside of 2A.
2. A minimum rating inside of 1013C.
3. A maximum travel to a fire extinguisher of 75 feet.
All fire safety appliances and exit signs shall be properly operating.
HeronHarbor-04-04-1 56-6-3.4 Page 1
i
If you have any questions or the required modifications are completed, please contact
me at the above office.
Yo rely,
Robert Fisher
Fire Inspector
Cc: Chief, Southold Fire Department
HeronHarbor-04-04-1 56-6-3.4 Page 2
x
Garrett A. Strang
Architect
1230 Traveler St., Box 1412
Southold, New York 11971
Telephone (631) 765-5455
Fax(631) 765-5490
January 29, 2004
Mr. Damon Rallis
Southold Town Building Department
Main Road
Southold,NY 11971
Re: Terning Point Inn, Main Road, Southold,NY
Dear Damon:
Pursuant to our telephone conversation earlier today, please be advised that the referenced entry porches
are 5' deep by 110' in length(one on each level).
Please advise the fee amount at your earliest convenience, so that I can obtain same from my client.
I trust this answers your question and thank you for your courtesy with respect to the above referenced
project.
Very truly yours,
Garrett A. Strang, R.A.
Architect
Enc.
' FIRE INSPECTION SURVEY
HERON HARBOR MOTEL 56-6-3.4
61600 MAIN ROAD SOUTHOLD
SOUTHOLD 11971 765-2445
3/23/04 • R FISHER
• WILLIAM LIEBLEIN • OWNER
Levels SlU, 1 U loorAr_ea
Asserribl loor`Aiea Occr and 'Ctass, R1 , u ;LOW 1 12 UNITS
Occupancy,Certificate NO Mixed Occupancy NO Const. epariaition OK
1d ,N . meas NO
fiffiffiff 1r►te�r�r W�Ns WOOD E446r,Wa#s WOOD
interior. Walls' GB ExtoriorWalls VINYL
Ili, GB Rope- ASPHALT
DOORS - ASST Exterior METAL
11*Ei r YES Fire, reS 'f. OK
wifil Yes/No YES Insp Date/Due 3/23/04
Manute/Local I LOCAL Comments HEAT&SMOKE EACH UNIT
• • • No. of Heat 12 No, of Smoke 36
•••- Adequate YIN YES Number
Width 36 Height 80 Barin Proper YIN'; YES
HardwarePro mer YIN YES Panic Bars,YIN NO Exit Signs YIN' YES
Lodke .pg Sian YIN NO Comments
ILLUMINATIONEXIT Mems or cess OK #of Exit.Si ns 2
—0(E- r . Lights] 0 Se Circuit's > N/A Exterior lllumin, `: OK
Am le# YIN NO Locations ASST
TypeABC Number 16 Date/Insp. Due
mrnent: TO BE INSTALLED
HOOD Semi:Annual Insp. N/A Greasecculm.
t�anr'n....,.Due'` Iris } `ciior�Due
••• Rahn 1.5 40rdwre OK
f METAL Closln �rxCe HINGE " Ltehtr OK
:.
ED. Conne'6 on NONE W DrylCombo
0.8.&Y. Valve Test Date Inspection Due
Pe: # lMO in U ype Comments
HAIR �u GAS
�oc4i6n EACH UNIT Ducts f Dampers ' DUCTS 5mok Deteirtors YES
Auto Shut-oft YES Condition NEW Housekeeping OK
HOT WATER Fuel` GAS Location RM 13
Qnaition NEW Houseke
757OK
ELECTRICAL - Size A 400+ Location RM'1 3
%ircut 'rotection BREAK Openings in Panel NO Open Boxes NO
Extension Cords NO Panel Clear&Acc YES Meter Clear&Acc
Grounding OK Condition INDIVIDUAL SUB PANELS
HeronHarbor-FIS-04-03 411104
' FIRE INSPECTION SURVEY
•" ••' �c 72+ 96
� .
OPEN NO
' : • 48+ r
Eracls�ir NOS NO N/A
Uiitlr! NO NO YES
NO Cirrt•t is" FROM 2ND LEVEL
' t NONE ,
n erg !leiit.
• . . Ali iiaPra
PROTECTION
• • NONE
l POP isovr
• Stvr
Se errs rsm ltd General C��► /gin
. . • Type NONE
ratlnn Safe# Cvt# #Jnrr
I . • Ic6mmeMs
" NONE
'I arch CQr , ' is
ADDITIONAL
EACH UNIT 12
FIRE EXTINGUISHER IN KITCHEN, SMOKE DETS, HEAT IN KITCEN, STROBE
AND FLASHING LED, CO DETECTORS, FIRE DOORS TO HEATER ROOMS
1 &5 MISSING EMERG SWITCH PLATES
INSULATION IN ROOM 13 TO BE COVERED, SPACE TO BE CONDITIONED
GAS SERVICES THAT ARE EXPOSED TO BE PROTECTED
MAXIMUM TRAVEL TO A FIRE EXTINGUISHER IS 75 FEET
MINIMUM FIRE EXTINGUISHER RATING FOROUTSIDE IS A 2A RATING
MINIMUM FIRE EXTINGUISHER RATING FOR INSIDE IS A 10 BC RATING
HeronHarbor-FIS-04-03 411104
J
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION i ST [ ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ] INSULATION
[ J FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY FIRE SAFETY INSPECTION
REMARKS:
DATE 13 INSPECTOR
FF01�►�o
Town Hall,53095 Main Road
A:1 Fax(631)765-9502
P.O.Box 1179 Telephone(631)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Fire Inspection Report 2004Report 2004
April 1, 2004
Mr. William Leiblien
Heron Harbor Suites
62300 Main Road
Southold, NY 11971
Dear Mr. Leiblien:
Thank you for the cooperation during the fire inspection of Heron Harbor Suites on
March 23, 2004.
jNew and existing buildings shall have building numbers placed in a position to be
plainly legible from the street or road fronting the property. The numbers shall be a
minimum of 4 inches high. Your building number is 61600.
During the inspection the following violations were noted and should be corrected
immediately.
Missing red emergency switch plates are missing in units 1 and 5.
The insulation in unit 13 (utility room) shall be properly covered as the space is a
conditioned space. The space shall meet applicable codes for construction and use.
Gas services that are exposed shall be protected. This pertains to the gas services on
the parking lot side.
Fire extinguishers shall meet the following requirements.
1. A minimum rating outside of 2A.
2. A minimum rating inside of 1013C.
3. A maximum travel to a fire extinguisher of 75 feet.
All fire safety appliances and exit signs shall be properly operating.
HeronHarbor-04-04-1 56.6-3.4 Page 1
-rU T. TERRY �' `� I uri H:ril. 51(lyC Llarrr Roo
P.O. Ilex 1179
N �
TOWN CLERK0-1 �r'i �- Suulhold. Nc\�
t}� Turk 1 Ir X71
ttEC151RAR Of VITALSTAT1SIlCS ✓- (� �� Fax (510) 765.1 R21
n6ARRIAGE OFFICER Tcicrhunc (S I( ) 7(,,,-1}(()I
RECORDS MANAGEMENT OFFICER
.i
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERIC
TOWN OF SOUTHOLD
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 :
RESOLVED that the Town Board of the Town of Southold hereby adopts
two (2) new forms to be used under the Flood Damage Prevent regulations
of the Code of the Town of Southold: "Floodplain Development Permit
Application" [FDP(93) ] , and "Certificate of Compliance for Development in
Special Flood Hazard Area [C/C(93)] .
_ D
8LL%3. 05-
TOWN OF SOUTHOLD
/Judith T. Terry
Southold Town Clerk
August 25, 1993
APPLICATION h_
f PAGE 1 of 4
TOWN OF SOUTHOLD
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
This form is to be filled out in duplicate.
SECTION I• GENERAL PROVISIONS (APPLICANT to read and si�n):
1. No work may start until a permit is issued.
2 The permit may be revoked if any false statements are made hcrein-
3. If revoked, all work must cease until permit is re-issued.
4. Development shall not be used or occupied until a Certificate of Compliance is issued.
S. The permit will expire if no work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory
requirements.
7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable
. inspections required to verify compliance.
8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO
_ THIS APPLICATION ARE,TO THE BEST OF KNOB DGE,TRUE AND ACCURATE.DATE 5///(APPLICANTS SIGNATURE)
Q
SECTION 2• PROPOSED DEVELOPMENT (To be completed by APPLICANTI
NAME ADDRESS
�J C TELEPH NE
APPLICANT Jdi/?
BUILDER
2�1�6T'GGT"� L�j4dlti�i �� �(tiA�l�-
PROJECT LOCATION:
• To avoid delay in processing the application, please provide enough information to easily identify the project
location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the
distance to the nearest intersecting road or well-known landmark A sketch attached to this application showing
the project location would be helpful"
-�5d12X-c s Ae-,-4 c f z- lJ 171® 5t_ i
FDP(93)
A
APPLICATION
PAGE 2OF4
DESCRIPTION OF WORK (Check all applicable boxes):
A. STRUCTURAL DEVELOPMENT
ACTIVITY STRUCTURE TYPE
❑ New Structure O Residential (114 Family)
❑ Addition O Residential (More than 4 Family)
❑ Alteration ❑ Non-residential (Floodproofing? ❑ Yes)
O Relocation ❑ Combined Use (Residential & Commerdal)
❑ DemoRion ❑ Manufactured (Mobile) Home (In Manu-
0 Replacement factured Home Park? ❑ Yes)
ESTIMATED COST OF PROJECT S
B. OTHER DEVELOPMENT ACTIVITIES:
O Fill O Mining O Drilling O Grading
❑ Excavation (Except for Structural Development Checked Above)
❑ Watercourse Alteration (Including Dredging and Channel Modifications)
O Drainage Improvements (Including Culvert Work)
❑ Road, Street or Bridge Construction
O Subdivision (New or Expansion)
O Individual Water or Sewer System
O Other (Please Specify)
Alter completing SECTION 2, APPLICANT should submit form to Local Administrator for review.
SECTION 3 FLOODPLAIN DETERMINATION (To be completed by LOCAL AD14fINISTRATOIt)
The proposed development is located on FER-M Panel No. Dated
The Proposed Development:
❑ Is NQJ located in a Special Flood Hazard Area (Notify the applicant that the application
review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
❑ Is located in a Special Flood Hazard Arca.
FIRM zone designation is
100-Year flood elevation at the site is: Ft. NGVD (MSL)
❑ Unavailable
❑ The proposed development is located in a floodway.
FBFM Panel No. Dated
❑ See Sccuon 4 (or additional inscructioos.
SIGNED DATE
APPLICATION
PAGE 3OF4
SECTION 4 ADD(TIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATORI
The applicant must submit the documents checked below before the application can be processed:
❑ A site plan showing the location of all existing structures, water bodies, adjaccot roads, lot
dimensions and proposed development.
❑Development plans,drawn to scale, and specifications, including where applicable:details for
anchoring structures, proposed elevation of lowest floor (including basement), types of water
resistant materials used below the first floor, details of floodproofing of utilities located below
the fust floor and details of enclosures below the first floor.
Also
❑Subdivision or other development plans (If the subdivision or other development exceeds 50
lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations
if they are not otherwise available).
❑ Plays showing the extent of watercourse relocation and/or landform alterations.
❑ Top of new fill elevation Ft. NGVD (MSL).
r
Ft:NGVD (MSL). For
❑ Floodproofing protection level (non-residential only) (
floodproofed structures, applicant must attach certification from registered engineer or
architect.
❑ Certification from a registered engineer that the proposed activity in a regulatory floodway
will not result in any increase in the height of the loo-year flood. A copy of all data and
calculations supporting this finding must also be submitted.
❑ Other.
SECTION 5 PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR-)
I have determined that the proposed activity. A. ❑ Is
B. ❑ Is not
. in conformance with provisions of Local Law , 19 The permit is issued subject to the conditions
attached to and made part of this permit.
SIGNED DATE
If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated
fee.
If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may
revise and resubmi( an application to the Local Administrator or may request a hearing from the Board of
Appeals.
- , APPLICATION N
PAGE 4 OF 4
APPEALS: Appealed to Board of Appeals? ❑ Ycs ❑ No
Hearing date:
Appeals Board Decision --- Approved? ❑ Yes ❑ No
Conditions
SECTION 6• AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance
is issued
The following information must be provided for project structures. This section must be completed by a
registered professional engineer or a licensed land surveyor (or attach a certification to this application).
Complete 1 or 2 below.
1. Actual(As-Built) Elovation of the top of the lowest floor, including basement an Coastal High Hazard
Areas bottom of lowest structural member of the lowest floor, excluding piling and columns) is:
FT. NGVD (MSL).
2. Actual (As-Built) Elevation of floodprooftng protection is FT. NGVD (MSL).
NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant.
SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR)
The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to
ensure compliance with the community's local law for flood damage prevention.
INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO
DATE BY DEFICIENCIES? ❑ YES ❑ NO
DATE BY DEFICIENCIES? ❑ YES ❑ NO
SECTION 8• CERTIFICATE OF COMPLIANCEM be completed by LOCAL ADMINISTRATORI
Certificate of Compliance issued: DATE: BY:
1
Attachment 8
SAMPLE
CERTIFICATE OF COMPLIANCE
for Development in a Special Flood Hazard Area
,r
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA
(0"'NER MUST RETAIN THIS CERTIFICATE)
PREMISES LOCATED AT: PERMIT NO.
PERMIT DATE
OWNERS NAME AND ADDRESS: CHECK ONE:
O NEW BUILDING
❑ EXISTING BUILDING
❑ VACANT LAND
THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW:
A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19
SIGNED: DATED:
B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # ,
DATED
SIGNED: DATED:
C/C(93)
1171 76.
BUILDING DEPT.
INSPECTION
[ ] FOUNDATIOT [ ] ROU L13G.
[ ] FOU ATION 2ND SOLATION
RAMING [ j FINAL
[ ] FIREPL CE 8 HIMNEY
REMARKS �11ZX
71
DATE INSP
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATI ST [ ] ROUGH PLBG.
[ ] FO ATION 2ND [ ] INSULATION
[ RAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMA
DATE � � INS
24? (A 0)
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU N
[ ] FRAMING INAL
( ] FlREPLAC HIMNEY [ ] FIRE SAFETY INSPECTION
RE RKS:
DATE // /4/') INSPECTO
� ass-iso2
BUILDING DEPT:
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING �[ ] FINAL
( ] FIREPLACE & CHIMNEY �nG],FIRE SAFETY INSPECTION
V 1
. REMARKS:
DATE � 2'3 � INSPECTOR
F LD INSPECTION REPORT DATE CO1VIl +NTS' ,�.
FOUNDATION(1ST) .
C
FOUNDATION(2ND) t�17
C
ROUGH FRAMING& ms `s
PLUMBING H
INSULATION PER N.Y.
H
STATE ENERGY CODE y�
Al
FINAL
ADDITIONAL CON MIENTS
0
m
_ y
G �
x
e
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: 765-1802 �' Survey
PERNIIT NO. I Check
Septic Form
N.Y.S.D.E.C.
2 Trustees
Examined I 20 Contact:
Approved If20� Mail to:
Disapproved a/c
WIN Phone:
Buildingbi=Te
_ APPLICATION FOR BUILDING PERNIIT,
6 .:`;
Date. Si , �0c__)&2
k INSTRUCTIONS
a..T1 s appltcati=MUST.be completely filled in by typewriter or in ink and submitted to the Building Inspector with,3
sets of planste 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 waterways.
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 issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection throughout the work-
e.
orke.No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupancy
is issued 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.
(gignature of applicant or name,if a corporation)
f O oX /¢/Z c�rJ��/o�./V`1 /�97/
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber.or builder
/d2c�
Name of owner of premises )eEAa 4 7-
(as on the tax roll or latest deed)
If applic t is a corporatio signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. �✓�,a
Plumbers License No.
Electricians License No,
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number Street Hamlet
County Tax Map No. 1000 Section S� Block to Lot 3,
Subdivision Filed Map No. Lot
(Name)
ate existing use and occupancy of premises and intended use and occupancy of proposed constructions
c�T�
a. Existing use and occupancy /L1
b. Intended use and occupancy
T"e L
Addition Alteration ?�
3. Nature of work(check which applicable):New Building Work
Repair x Removal Demolition
(Description)
4. Estimated Cost 2 S oo a Fee
(to be paid on filing this application)
5. If dwelling,number of dwelling units ro Number of dwelling units on each floor
If garage, number of cars AIA
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. a
7. Dimensions of existing structures,if any: Front //O
Reaz //o Depth Z 8
Height Z 3 Number of Stories
Dimensions of same structure with alterations or additions: Front //U Rear
/!v 2
-Depth - 2 Height 3 Number of Stories.
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories .
9. Size of lot: Front
2 2. 9 r'. Rear /9S' r Depth �if .38 �• Z
10. Date of Purchase
!Ji✓�!ivow� Name of Former Owner 4.)AI14A.110 l/
11. Zone or use district in which premises are situated At A
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be re-graded ^1a Will excess fill be removed from premises: YES NO
14. Names of Owner of premises Address Phone No.
Name of Architect .y7X A A-JG Address Phone No
Name of Contractor Address Phone No.
15. Is this property within 100 feet of a tidal wetland? *YES X NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
16. Provide survey,to scale,with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OrS!2, n
&A 216 r1 /9. �1 r/z A n/G being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the X Q-e&I T—K7 IAC F.iT'
(Contractor,Agent,Corp rate Officer, etc.)
of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
STS day of 46E cery,6 ert 20 l6 7/
Notary Public Signature of Applicant
bar0ara A, Strang
NOTARY PUBLIC, New York
No. 473095
'qualified - Suffolk County
amm: Fxnires .July 31,200 2-�
Permit Number
Myr.h,4ee,k Conupliai eie Report ChockedBy/Date
New Mork State Energy Conservation Construction Code
MECcheck Software Version 3:3 Release Ic
Data filename:Untitled
TITLE:C&L Realty
COUNTY: Suffolk
'STATE Nein York
*MD:5750:
CONSTPPi TdONTYPE:Multifamily
11EAT1NG TYPE:Non-Electric
DATE: 12/05102,
DATE GO PLANS:June 7,2001
PROTECT INFORMATION:
Terrting'Poiut Inn
Rt 251
Southold(NY 11971
lig
cow ' INFORMATION: �F Q VEST A AST q C�
Crarrett�Sir6g,PLA-
Son
RASoutl`sb1� IY'' 11971 �, ,�.r/�•,�. �
L524C
COtySPLI�NCE:Passes
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Maximum TJA=201
Your Home 7 110
45.3pf BeUerThan Code
Cross Glazing
!, Area or Cavity Cont or Door
{ !,I Perimeter R-Value R-Value U-Factor UA
Ceiling 1{•{Flat Ceiling or Scissor Truss 459 38.0 0.0 14
I Wall L V ood Frame,16"o.c. 774 13.0 0.0 60
Window I:Wood Frame,Double Pane with Low-E 27 0.340 9
Door 1: lid 20 0.330 7
tj- Floor 1: -Wood Joist/Truss,Over Unconditioned Space 459 21.0 0.0 20
'COMPLIANiM STATEMENT: The proposed building represented in this document is consistent with the
building plans,specifications,and other calculations submitted with this permit application. The proposed systems
have beef designed to meet the New York State Energy Conservation Construction Code requirements. When a
Registered Design Professional has stamped and signed this page,they are attesting that to the best of his/her
knowledge,beliet,and prof ' judgment,such plans or specifications are in compliance
��with
''this Code.
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