HomeMy WebLinkAbout30318-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,
CERTIFLCATE OF OCCUPD~CY
Date: 09/10/04
CERTIFIES that the building
ALTER3ITIONS
Location of Property: 61600 ~AIN RD
(HOUSE NO_) (STREET) (~APLLET)
County Tax Map No. 473889 Section 56 Block 6 Lot 3.4
SOUTHOLD
Subdivision Filed Map No. -- Lot No.
conforms substantially to the .Application for Building Permit heretofore
filed in this office cl~ted APRIL 14, 2004 pursuant to which
Building Permit No. 30318-Z dated ~AY 17, 2004
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 "AS BUILT" A_LTER3kTIONS TO A-~ EXISTING SHOWROOM AS APPLIED FOR.
~e certificate is issued to C & L REALTY INC
(O~R)
of the aforesaid building.
SIIFFOLK COUNT~ DEPDRITMENT OF ~]E;kLTH i~PPROVAL
ELECTRICAL CERTIFICATE NO.
PLIERS CEHTIFIC_~TION DAT~
N/A
N/A
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)
~ERMITkNO. 30318 Z Date MAY 17, 2004
Permission is hereby granted to:
& L REALTY INC C
MAIN ROAD
SOUTHOLD,NY 11971
fer :
AS BUILT ALTERATIONS TO AN EXISTING SHOWROOM AS APPLIED FOR.
ADDITIONAL CERTIFICATION MAY BE REQUIRED.
at premises located at 61600 MAIN RD
County Tax Map No. 473889 Section 056 Block
pursuant to application dated APRIL 14, 2004
Building Inspector to expire on NOVEMBER 17, 2005.
Fee $ 400.00 ~
~thor'~ture
SOUTHOLD
0006 Lot No. 003.004
and approved by the
ORIGINAL
Rev. 5/8/02
Form No. 6
TOWN OF sourItOLD
BUII,DING DEPARTMENT ?
TO,tN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Tkis application must be filled in by typewriter or ink and submitted to the Building Department with the follo~4ng:
A. For new building or new use: 1. Final surveybfproperty with accurate location of ali buildings, property lines, streets, and unusual natural or
topographic featttres.
2. Final Approval fi:om Health Dept_ of water supply and sewerage<lisp~sal (S-9 form).
3. Approval. of electrical installation fi-om B o ard of Fire Undenm:itars.
4. Sworn. statement fi-om plumber ce~ng ttmt the solder used in system contains less than 2/10 of 1% lead.
5. C0flh:aerc/.al.building, industrial btfilding, multiple residences and similar buildings and inatallations, a certificate
of Code Compliance from arohitect or engq_neer responsible for the building.
6_ SUbmit Pianning Board Approval o f completed site plan requirements.
B. -For eaa'sO, ng4mildlngs-~rior-to~fil:9, 19~7Maon-cqmlorming~ses, o~tmitdiags~nd~pl~e~g~' land,scs:.
1..Acorn:ate survey of property showing all property lines, streets, bffdding and unusual mt.m-al or topographic
features.
2. A properly completed application and consent to impcct si~med 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 dwell'rog $25.00,
Swimming pool $25.00, Accessory budding $25.00, Additions to accesserT 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. Temporat3~ Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction: Old or Pre-existing Building: '~' (cheek one)
LocafionofProperty: ~91 ~C ~'46Lia ~
House No. , St~ect Hamlet
Owner or Owners of rroperty: ~-.~+~ {-~-~%-J~, ] ~[.{.{CL~,
Suffolk County Tax Map No 1000, Section '~/ '~ ~ al Block
Subdivision
PermitNo. ~ 0 3 [ ~ ~- DateofPermil. ~A~I
Health Dept. Approval:
planning Board Approval:
Request for: Temporary Cert/fieate
Fee Submitted: $
Filed Map. Lot:
Underwriters Approval:
Final Certificate:
Applicant Signature
T O~;V~ CLE 17~K
OFFICE OF T~E TOWN CLERK
TOWN OF $OUTHOLD
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 2~, 1993:
RESOLVED that the Town 8oard of the Town of Southold hereby adopts
two [2) new forms to be used under tl-le Flood Damage Prevent. regulations
of the Code of the Town
Application" [FOP[93)], and
Special Flood Hazard Area [C/C(9])1.
i L!L~ ......
L
~LDG. ~E~T.
TOW%~UTh~OLD '"
of Sauthold: "Floodplain Development Permit
"Certificate of Compliance f;Jr Oev'elopment in
. Terry
5outhold Town Clerk
August 25, 1993
(
TO~H OF SOUTHOLD
APPLICATION #
PAGE I o1' q
FLOODPLA_[N DE~,rELOPMENT PER~'IIT APPLICATION
This [orm is to be filled out in duplicate.
'~..~ .?% SECTIQ/',[; , 1 GENERAL PROVISIOI~S (,,kPPLIC,&JTI' to read and sigh'l:
~ ~ Th pcrm£1t may ~ rcmk~ ff ~y [~c stat~ca~ ~c made hcrcm_
:. ~-~ 3.. ff:~evok~ ~ work m~t ~e ~tfl pe~tt ~ re-~ued_
, ')~ 4~5. De~dopmeht s~ not ~ ~ed or ~icd unt~ a Cert~mtc o( ~mpfi~< ~ ~ucd
'r ~..6~fi~t ~ hereby ~o~ed that other pe~t~ may be rcq~ed to ~ Io~ state ~d federal re~ ato~
To~}~id delay ia p,'-m:v_ssh~g thc ~ppLicacio~, plc~e provide enough h:fformadoa to ~Hy idcnt~ thc project
~1."~ Pr~de ~e ~e~. addr~ lot numar or le~ d~p~ion (aUa~) ~d, ou~ide ~. ~, the
dk~ to ~c n~m mt~scm~g road or v.%~ k=o'~m ~h A skc[~ atta&ed to ~ appE~txon sho~g
thh~i~jic~ I~fioa wo~d be helpS. ~ ~ ~ .
,: Pr93}
Dix$CJ~IFTION OF WORK (Check zll applicable boxes):
· A_:STRUCTURAL DEVELOPMENT
APPLICATION
PAGE ~ OF' ~
ACTIVITY
· ~TRL~CTU RE. TYPE
[] New Structure [] Residential (14 Family)
[] Addition , [] Residential (More than 4 Freely)
[] Alteration ~. Nao-rc~idential (Floodprool-mg? [] Yes)
[] RelocaUon [] Comb[ned Usc (~.e~ideuu. M & Commcrc:hJ)
[] Dem0[idod ' , ,- t~ r-I Manufactured (Mobile) Home (la
~Replacement?,(~r~-~A'/,~-Sf' ['acturcd Home Park?. [] Yes)
ESTIMATED COST OF PROJEC-F $ ~z//ff,/d~'~
B_ ~E.R DE~ELOPbfEIq'I' ACTIVITIES:
Fdl 0 Mb.~g FI Drfllbg [] Gradbg
Excamfioa (l~:cept for Structural Development Checked Above)
Watercourse Alteration (Including Dredging and Charnel ModLfic~tiorm
Drabag¢ Improvement~. 0.nduding Ctllvert Work)
R~ad, Street or Bridge Cooxmuction
SabdJvbloa (New or F~paasioa)
fnd~dual Water or Sewer System
peci[7)
A. fg~'.~.,~"comp cting SECTION 2. A~PL[C,~J',rT shougd xubmlr form to Local Administrator
~E~0N 3: FLOODPLArlff DETERMINATION I'To be completed by LOCAL A. Dbf[ixHSTRATOR.~
Thp-~[groposcd development i~ loc:aced on FI~,~{ P~.nel No. Dated
Ttte:~ropo~ed Development:
[] hi ~ located in a Spcdal Flood Harard Ama (Notify the applicant that thc application
rc-~iew Lq oomplete md NO FLOODPLAJlq DEV~c.i~O PMF_Jq-F PER/.dlT IS REQUIRED).
~ i~ located i~ a Spc. cial FIo,>t H ~azxrd Area.
100-Yeaz flo,xl elevation at thc site b: Ft. NGVD (MSL)
[] UaavaJJablc
[] Thc proposed development is located ia a Iloodway.
lq3Ft4 ?~ct No. Dated
AJa P LI CATIOI'~ ~
PAGE 3 OF 4
SF'CTION 4: ADDtTION/,.L [NFOflJ~ATION R~QUI~R£~D (To hc c~ompletcd by L0~AL ADMIHIST'_RA~OR~
The. applicant must submit the documents checke, d below before the. applicadon ~ bc processed.
[] A sit: plan showing thc location of ail c~stmg structures, '~,'ascr bodi,'s, adjacent roads,
dimeusio~ and proposed deve. lopmeat.
[] Development plans, dra~-n to scale, and spedficati~, including where appticablc'_ details for
anchoring structures, proposed elevation of lo'vest floor (induding basement), types of water
msbtant m~.tcrials used below thc [-trgt ~loor, deta~la of floodprooi-mg of utilities located b¢lo~
the first floor a~d details of endosttres below thc. first floor_
[] Subdivision or other development plan~ (if the subdivision or other development exceeds $0
lots Or 5 a~-ez, whichever b the lesser, the appliexm must pro'Adc lO0-ye~ flood elevatioixs
if they ~r¢ not other~c available).
[] Pla.~ showing the e.~tent of watercourse reloeatlon and/or land,ore alterations.
El Top of new l,ll cio'ration
Ft_ t~GVD (MSL).
[] Floodproofmg protection level (non-residential only) Ft~ NGVD (N[.SL). For
floodproofed strueturex, applicant mu.st attach certification [rom registered engine, m- or
arcl~it~
CertLl%~tioa [rom a registered engineer that thc proposed activip/in a regulatory floodway
will not rexult in .~ increase ha the height of thc 100-yea.r flood. A copy of all data a~d
calctflatin~ supporting th~ £mding mo-st also be submitted.
Other:
SE(yI'ION 5: PERMIT DETERMINATION Ufo be completed b'f LOCAl. ADMINU~'TRATQR}
[ hive deteamnined that the propoaed activity- A. n Is
It. ~1 Is not
in o0nformancc with provlxions or Local Law ~ , 1~
attached to a~d made part of this permit.
SIGNED , D,~ '~E
. The permit b Lzsued subject to the conditions
fl~.~,X .a,~checkcd_ thc Uoc.d AdminJ~tralor m~y ksue a Development Pe~it upon pa)~eut of dcsi~atcd
BOX B ~d, thc tm~l Admi~stramr '*~l pro~Sdc a '~itten summ~ of dcficienci~, Applier may
rw/Isc and resubmit ~ appg~tion to [he k~l ,Administrator or may request a bearbg from the Bo~d of
Appc~s.
.ApPF_AJ~. Appealed to Board of Appeals? 0 Yci 0 No
Hcazi.ng date:
Appeals Board Decbioo --- Approved? [] Yes
Con c[Jtio ~s
0 No
APPLICATION
PAGE ~ OF 4
SECTflON 6; A~-BUILT ELEVATIONS fTo be submitted by APPLICANT be[ore Ccrtific2tc of Compliance:
is issued)
The [ol~owbg kLformaUon moist be provided for project :tructures_ Th~ section must be completed ~y a
registered profc.~ioqal cugineer or a [iccn_~ed l~od surveyor (or attach a certification to this application).
Complete 1 or 2 below_
L
Actual (A~-Built) Elevation of thc top of thc lowest floor, i~ducthag basement (ia Coastal High l-laza'rd
Axons, bottom of lowest structural member of the. lowest floor, e.~cdudlng pilhag ;md colttmm~) is:
Fr. NOV'D (MSL).
L Actual (A~-Built) Elevation of floodproo/-mg protection b FT. i'lGX,rlD (MSL)_
NOTE: A~y work perfortocd prior to submictaJ of the above hzforma~.ion b at thc rLck 3[ the Applicator_
SECTION 7: COMPLLA~CE ACTIQN CI'o be completed by LOCAl/ADMINISTRATOR'~
The LOCAL ADMtNt,f'TILATOR will complete, thts s¢~ioa ax applicabLe bused on L~spe. ction of dae project to
cn~ure compl;a~ce ,Mth the community's local law for flood damage prevention.
[NSPIECTIONS:
DATE BY DEFICIENCIES? [] YES [] NO
DATE BY DEFICIENCIES? O YES [3 NO
DATE BY DEFICIENCIES? [] YES [] NO
i,~_C-I'ION 8: CERTIFIt~ATE OF C01MPLIANCE(T9 be c0mple{ed ~¥ LOCAL ADM[NI:}TFRATQR)
C~rtificate of Comptia.uce isxued: DATE: BY:
Attachment
8k~PLE
CERTIF~CAT~ OF CO~PLIA/4CE
for Development in'a Special F].ood Hazard Area
TOWN OF SOIjTHOLD
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECLAJ~ FLOOD [-L,tZAP, A)
(OWNER MUST P.~TAIN THIS CERTIFICATE)
PREMISES LOCATED
PERMIT NO.
PERMIT DATE
OWNERS NAME AND ADDRESS:
CHECK ONE:
El NEW BUILDING
ID EXISTING BUILDING
[] VACANT LAND
THE LOCAL ADMINISTRATOR IS TO COMPLETE A_ OR B. BELOW:
COMPLIANCE IS HLER_EBY
LOCAL LAW # ,19
SIGNED:
CERTIFIED 'WITH THE REQUIREMENTS
DATED:
COMPLL4_NCE IS HEREBY CERTIFIED WITH TH_E REQUII:LEMENTS
LOCAL LAW #.__, 19__, AS MODIFIED BY VARIANCE
DATED
SIGNED: DATED:
OF
OF
C/C(93)
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] ROUGH PLBG.
[ ] IN,~SULATION
[ i,,~NAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:___ ~ ~-- ~-
DATEv~ /~, "~'~'~INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [
[ ] FOUNDATION 2ND [
[ ~FRAMING [
[ ] FIREPLACE & CHIMNEY [
] ROUGH PLBG.
] INSULATION
] FINAL
] FIRE SAFETY INSPECTION
FIELD INSPECTION REPORT I DATE I COMI~IENTS '
FOL'~DATION (1ST)
ROUGH ~G & ·
~S~A~ON PER N. ¥.
STATE ENERGY CODE
TOWN OtfT io 9
BUILI)IN~ DEPARTMENT
,TOX~ HALL
SOUTItOLI), NY 11971
~EL: (6~1) 765-1502
FAX: (631) 765-9502
~'. northfork.net/S outhold/
Disapproved
· Expkafion 20__
::R I 4
BUILDING PERMIT APPLICATION C~HECKLtST
Do you have or need the following, befoi-e~a~:plyi~g?
Board of. Health:
3 sets of Bulldifig Plans
Plmming Board epprova!
Sm-vey
Check
Septic Form
N_Y.S.D I:LC.
Tms~eg
Contact:
Phone: . ~i~ ~'/.i~
Bui[din= Inspector-
APPLICATION FOR BUILDIN'G PER,lIT
Date
INSTRUCTIONS
,20od
-a, Tl~f ~Pptlcatlon'I~YUg;F~g~0mpletely/filed in by typewriter 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 oflot 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 commcmced before issuance of Building Permit.
d. Upon approval of this application, tko Building Inspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection througJaout the work
e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
£ Every building permit shall expire if the work authorized has not commenced witNn 12 months afte3 the date of
issuance or has not been completed within 18 months fi:om such datk..~no zoning amandments or other regulations affecting the
property have been enacted in the interma- the Building Inspector may gO:dz~rize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permk shall bc required.
APPLICATION IS HEREBY MADE to tt/e Building Department for the issuance of a Building Pcrmit pursuant to the
Building ~one Ordinance of the Town of Southold, Suffolk County, New York and other applicable Laws, Ordinances or
Reguiations, for the consrrv, ction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant a~ees to comply with all applicable laws, ord'mances, building code, housing code, and regv. latious, and to admit
authorized inspectors on premises and in building for necessaD' inspections
(Signature of applicant or name, if a co~por~tion)
CM~iling address of applicant)
State whether applicant is owner, lessee, ageut, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises (~4 /
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name ~md title of corporate officer)
Builders License No_
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
L. la, o
House Number Street
CountyTax Map No. 1000 Section
Subdivision
(Name)
Hamlet
Block A
Filed Map No.
Lot ~. ¢
Lot
2: S~/t~ ekisfin~ use and 0cettpai~y'0fpremises and intended use and occupancy ofprop"osed construction: · .
a. Existing use ~d occUP~cy ~ ~/c~ ~o ~ o ~ ~
b_ Intended ~e ~d occupancy_ ~ ~
3. Nature of work:. (check which apphcable): New Building Addition Alteration
· Rbpair v/ Removal , Demolition Other Work
(Description)
4. Estimated Cost Fee
(To be paid on filing this apl~lication)
/
5. If dwell[ag, number of dwelling units ~,/'~ Number of dwelling units on each floor
If garage, number of cars
~.' 'If business, ~ommercial..oi- mixed occupancy, specify nature and extent of each t3pe of use. / ~ ~ /f, ~r~,,~ ,~.
· 7. Dimens/_ons of existing structures, if any:. Front /1 o Rear Heigh~ -~..-a~ Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height_ Number of Stodes . -.... :~ ~
8. Dimensions of entire new construction: Front
Height Number of Stories
9. Size oflot: Front ~g2r~.~ Rear goo-
Rear _Depth
Depth. ~o~.' 2-o,/5t q3"
I0. Date of Pttrchase
Name of Former Owner
11.
12.
13.
.14.
Zone or use district in which pretmses ale situated
,,',
Does proposed construction xriolate any zoning law, ordinance or regulation? YES
Will lot be re-gaded? YES__
Names of Owner of premises
Name of Architect
Name of Contractor
NO ~/ WiI1 e~&~_fill be removed fi:om premises? YES
(t.~/_ /~a,r? Address ,~o ,~7-,~ ,- ,3 PhoneNo.
Address Phone No
Address Phone No.
NO j
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES / NO __ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C_ PERMIT/~'MAY BE REQUIRED.
b_ Is this property within 300 feet ora tidal wetland? * YES t// NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED_
16. Prox4de survey, to ~cale, 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)
COUNTY OF ,~ (T-O oF-rS)S:
/~"~ ~IE,5I.~I,'J being duly sworn, deposes and says that (s)he is the applicant
{Name of individual si~n/ng contract) above named,
(Contractor, Agent, Corporate Officer, etc.)
o(said m~mer or owners, m~d is dui3, authorized to perform or hav,~ performed the said work and to make and file tkis application;
that all statements contained in this application are true to the best of his lmowledge mzd be[iefi and that the work will be
performed in the mamzer set forth in the application filed therewith.
Sworn to before me this
dayof /1~,~ c,q 200~
/ Nota~ ~blic ~
No.
Si~nature of Applicant