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HomeMy WebLinkAbout30636-Z FORM NO. 4 TOWIS OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30539 Date: 11;'08!04 THIS CERTIFIES that the building ALTEP_ATIONS Location of Property: 61600 MATH RD SOUTHOLD (HOUSE PIO. ) (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 SEPTEMBER 15, 2004 pursuant to which Building Permit No. 30636-Z dated SEPTEMBER 15, 2004 ,,.,as issued, and conforms to all of the requirements of the applicable provisions of the law. The occupanc:r for which this certificate is issued is "AS BUILT" ALTEF_zvTIONS TO EXISTING MOTEL UNITS AS APPLIED FOR. The certificate is issued to C & L REALTY INC (OPRIER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1206931 04/271104 PLUMBERS CERTIFICATION DATED N/A ut riz 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. 30636 Z Date SEPTEMBER 15, 2004 Permission is hereby granted to : & L REALTY INC C MAIN ROAD SOUTHOLD,NY 11971 for AS BUILT ALTERATIONS TO EXISTING MOTEL UNITS AS APPLIED FOR WITH FLOOD PERMIT AS REQUIRED. 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 SEPTEMBER 15 , 2004 and approved by the Building Inspector to expire on MARCH 15 , 2006 . Fee $ 500 . 00 Zzed Signature ORIGINAL Rev. 5/8/02 7A. �i�1j war- - Form No.6 TORN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY st be fflled in by typewriter or ink and submitted'to the Building Department with the following: ng or new rise: y 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 certifica 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 i 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 $t 5.00 Date. fJod. UK New Construction: x Old or Pre-existing Building: (check one) Location of Property: rd/ r0 0-0W 11/1 Pi • S"�'Kw`*^ Douse No. Street Hamlet Owner or Owners of Property. � Y 1 L'a F1�j Suffolk County Tax Map No 1000, Section Block,_ Lot , y Subdivision p Filed Map. Lot: Permit No. C tP 3 Date of Permit. I —0S - Uy Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 5c C-) C� �U✓3C15�� t G LP-7 1 licaXSigniiture O cPcPrJ�r fcPcPrJ�cPrJ�cPrJ�cPrJ�cPrJ�rJ�rPr��PrJ�rJcPcPrJR�rJ�cPrJRI�r>�rJrJ�cPr�rJrJar�rJ�rJ I :-I MrPrJ-@PLFQr�rJrJ FQ1-J@PrJ�r�rJ�rJ�rPrJ�rJ�PrJ�rJ�rJr O 5l 5 BY THIS CERTIFICATE OF COMPLIANCE THE NJ 5 NEW YORK BOARD OF FIRE UNDERWRITERS Ni 5 BUREAU 40 FULTTON STEETF NNEW CYORK,iNY 10038 5 5 CERTIFIES THAT 5 51 NJ 5 Upon the application of upon premises owned by 5 5 JIM SAGE ELEC. INC. C AND L REALTY C5 5 P.O. BOX 38 61600 MAIN RD. 5 r5 GREENPORT, NY 11944-0038, SOUTHOLD, NY 11971 5 C5 Located at 64300 MAN P.D. SOUTHOLD, NY 11971 rS ,7 Application Number: 1206831 Certificate Number: 1206831 5 Section: Block: Lot: Building Permit: BDC: nsl1 5 Described as a Contra ercial occupancy, wherein the premises electrical system consisting of 5 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 First Floor. Outside. 5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard 5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5 5 5 authority having jurisdiction, and found to be in compliance therewith on the 5 27th Day of April. 2004. 5 Name QTY Rate Raung Circuit Tvpe 5 5 Appliances and Accessories Dish Washer 5 0 11 KW 5 5 Exhaust Fan 6 0 F.H.P. 5 L5Furnace 5 0 Gas C 5 Air Conditioner 4 0 I8.000 BTU 5 Air Conditioner '. 0 30.01111 BTU 5 Panels 5 60 11 5 5 Wiring and Des ices 5 Receptacle 116 0 General Purpose 5 Switch 7S 0 General Purpose 5 5 Fixture71 0 Incandescent 5 Receptacle 16 0 GFCI 5 5 5 5 sea/ S 5 5 1 of l 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 5 D rJ�rJ@lrJ�rPrJ7tJ�rJ�rPc PrJ�rJ�rPcPrJ�rJ�rPr�cPcPtPrPcPrJ7cPr�rJ�rJ�rPrPrJ�rJ�rPrPrJ�rJ�rPrPcPcPtJ�cPcPrP rPrPcPcM:LTPLrPrPc-c3pL pLpcpLrJ@PrP o CHIEF OF DEPARTMENT Thomas HelinSki §aut4n1a 'ire Pepartment FIRST ASSISTANT CHIEF P.O. BOX 1469 SECRETARI William Witzke 55135 Alain Road Christina Berrc Southold, New York 11971 SECOND ASSISTANT CHIEF (631) 765 -3385 - Fax (631) -65 -5009 TREASURER Rick Weber Chiets' (631) -65-1240 Ronald Butkocich May 17, 2004 Dir. Michael Verity Building Department Town of Southold Southold. NY 11971 Mr. Verity, As Fire Chief of Southold Town. I ha%e spoken k�ith the owners of the C & L property at 61600 (`'Iain Road, Southold. I discussed Ivith `,William Lieblein the installation of a fence six feet high with an emergency access gate of sixteen feet on the northeastern entrance of their property. I have determined this opening to be sufficient for emergency vehicles to enter the property. The eastern driveway must have a clear opening from the Main Road side down to the docks at the southeast side of the property, next to the current fish market. Sincerely, William Witzke I" Assistant Fire Chief, Southold Town cc Southold Fire District Commissioners 'lit 2 2 1 jr, ,, D TOWN OF SOUTHOLD PROPERTY RECORD CARD /1-�� {,l£R STREET L;' VILLAGE DIST. SUB. LOT FORMEROWNER 5.C. 1.�-.A N E AGR. ge L Z. O C� 13 S W TYPE OF BUILDING /✓.C. lzNd<Is Rwd �HJd� �a.rJ.�1Ae Nc RES. SEAS. VL. I FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS Cea �,�et� _ _� �. { " ar. Z PAeCC S.�— I- r YO F1� TXEC /9,1"6o ZL 7aa J a /ir SAGe�/ // _ .azoleci ln.rd/,�s!1 _ 8 , ssn�i!uF.C' �tg �w.��, f•U .�J� C� L Ar11 DD14 "0 5 2 i o u S r.fir- -C— 37 O a zz - r ✓ 9 - i88So C of qj qq /skso 2' r. %7et.Yl ac Ish Markel . y a550 roo U- 0 a ©i L AG Tillable FRONTAGE ON WATER Woodland - FRONTAGE ON ROAD A J` p DEPTH A House Plot BULKHEAD i Total - _ y x DISTRICT SUB. LOT STREET VI! j - A(D 4+a�D ?NC- ER OWNER •N E r " ` ACREAGE 41 S W "Y)- f TYPE OF BUILDING I 3 ZES. SEAS. VL. FARM '`CO Z , I IND. CB. MISC. Est. Mkt. Value ; LAND IMP. TOTAL DATE REMARKS u'a / Z 7 /5' ,6 o400 0 7 z a / G a o 5'/i9, /s. G nn��� S >0— � O d r' a r.7 a• �:1 � '7 av-0e`, D rD� 'oZ F `-10 C7 s 16 �°1-fflN i 7/ TLE 7-fTL—�I-7AZ 44 �j . 6 t CON IcJN7 7'6 ✓ I-'CRat+ r 7 i �/ra/7kjO -� NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm 'Acre Value Per Acre Value FRONTAGE ON ROAD Z2 Lt j p U� Tillable 7 BULKHEAD Tillable 2 DOCK Tillable, 3' - JJoodland Swampland Brushland ouse Plot Total ' _F1, i I l y'I J6 - n + \ 6 i 1. Bldg, i Foundation - kB at O _ h I s Y — -- i o M iL/ o' o y ctension G x I _. 3 0 /[o ,� ff- B�eement Noors Ktension --26 /M - --- _X 79 1� Z Ext. Walls w,r Interior Finish ctension Fire Place Heat _ L� /gyp —� d• + Al' — / 2. QQ DO — - Porch - Roof Type - < a Q x s'Q- 2 Porch Rooms I st Floor ` nZaway I Patio Rooms 2nd Floor At- � Driveway I r Dormer )PO QL � I TOWN --OF -SOUTHOL6' O ------------ STREET VILLAGE DISTRICT SUB. LOT o4A,A7ARiNF C�NTEl2, FORMER OWNER N / ACREAGE E 6- r �6�© 'kms �� S W TYPE OF BUILDING RES SEAS VL. FARM CIND. CB. MISC. LAND IMP. TOTAL DATE REMARKS`- ---- TL L - 44- 000 -OcJa /V �o-mb GE B LDING C DITI N � EW NORMAL BtLO OVE Farm Acre Value Per Acre Value Tiilahle 1 Tillable 2 -- Tillable, 3 �y0 Woodland wampland ! T Brushland 6 L •'7 2 0 L o o I -blouse Plot -- ' /�c� r 7/ 7 �•,� / � ` . 7" s—o;J . Tatal► % 66 = i I AH f I LH-- i, i i �: JJ i � 1 r� r � I i I II I� r 6t /_d,�lj� 6 6� Foundation Bath _ tea/" — — - tensi n Basement _ ,SO X � �f0 � i Floors tension — Ext. Walls Interior Finish tension Fire Place Heat �— Porch Attic Porch Rooms 1st Floor eezeway — - Patio --- I— Rooms 2nd irage Driveway j 60� 0 " TOWN OF—SOUTH. OLD -PROPERTY RECORD .$',el' STREET VILLAGE / DIST. SUB. LOT' O NER N E ACR. TYPE OF BUILDING 4,)' i SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS 0-4&C) Tr I 3So� (D AGE BUILDING CONDITION - EW NORMAL BELOW ABOVE 5z 437, , i <-qg 4- s/g� kRM Acre Value Per Value Acre l lable 1 lable 2 lable 3 odland 3mplond FRONTAGE ON WATER ishland FRONTAGE ON ROAD use P DEPTH BULKHEAD tal DOCK _ _-- ----- - COLOR 1 - - -- t Tr- c � c TRIM i t• C t— _ 2 .e Z_' ..aN- "'dg- ?Q X2- 6 =/94 Foundation Bath Dinette /3J � Base ✓r:.,.!;ir .0 xtei uwn 5!.6 ! 33 S/ / ✓ ment Floors y - K. _ Ext. Walls �_ , .; Interior Finish LR. E Y ensicr. Fire Place Heat DR. I I _ Type Roof Rooms Ist Floor BR. �k J Y 6 JJ Recreation Room Rooms 2nd Floor FIN. B. I Sx � tl = 3s-U 7r74 � �_ I tl,ci — ,Dormer Breezeway Driveway Gar.-fie Patin 10 G. B. L o Total's r I ( f JtijldJ-H T. TERRY G� - ' C „n Ilall S 111Yt Alam ' TOWN CLEP3t o •! R P O. floc 1174 I `nulhnld N", lurk I IlEGl5rMAR OF MAI. ST,%T1,11C .�'" (C�b MARRIAGE OFFICI:R '�, '• �� I-' I l'I ���.I Ci?\ `�-�•. ��. Tcicphunc ltlf�l 7!15. 11 RECORDS M114AGCMENT OFFICER -,�" �� _ I FREEDOM OF INFOfWAT-10N ()FFICF R OFFICE OF THE TOWN CLERK 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 .A.ppliea ,irn" [ FDP(93) ) , and "Cer'tifil_ate of Cnrnpliance for Development in Special Flood Hazard Area [C/C(93) ) . t TOVvTI OF SO:TT±OLD — l1 `Judith T - Terry Iouthold Town ClerH August 25 , 1993 • APPLICATION a PAGE In( 4 LOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERNILT APPLICATION This Corm is to be filled out in duplicate. SECTION I: GENERAL. PROVISIONS (APPLICANT to read and siO L. No work may start until a permit is issued. 2 The permit may be revoked if any fake statements are made herein. 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. 5. The permit will expire if no work it 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 coo=t 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 APPIICATION ARE,TO THE BES F MY KN VLEDGE, TRUE AND ACCURATE. I (APPLICANTS SIGNATURE DATE DATE y/sS/GT SECTION 2: PROPOSED DEVELOPMENT LTo be complctcd by APPLICAl,,M _ HAM ADDRESS TELEPHONE APPLICONl- �,CR/(r / T1 - �//.'•ni✓5 �Z 3d /2.rU4C 4.t S% So;/"F(/-[d 7G5 S 9RS s BUILDER �r�1dGTNEETt �- _ _ /�"Clt,i�c7 �1 A•A�l mac(/ tel. ��nryJ�)• /z� lQ4v ft4st���> - ��5�5�3 PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily ideutify 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 vrll knok-u landmark A sketch a(tached to this application showing the project location would be helphd. %ate -i r _ ---- -- FDP(91 ) APPLICATION _ PAGE _ OF J DESi_RIPTION OF WORK (Check all apphcablc bones) .. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure 0 Residential (1-4 Family) _ 0 Addition jQ Residential (More than 4 Family) S Unv, r5 L $I Alteration 17 No❑-residenual (Floodproofmg? 11 Yes) 0 Relocation 0 Combined Use (Residential & Commercial) ❑ Demolition P 0 Manufactured (Mobile) Home (In Manu- 3 factured Home Park? 0 Yes) IE'E Ff,e F5r5N IX j ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: — Ale.ltroe_7 0 Fill 0 Mining 0 Drilling 0 Grading 0 Excavation (Except for Structural Development Checked Above) _ 0 Watercourse Alteration (Including Dredging and Channel Modifications) 0 Drainage Improvements (Including Culvert Work) 0 Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) . ❑ Indirvidual Water or Sewer System 0 Other (Please Specify) - After completing SECTION 2, APPLICANT should submit form to Loc-31 Administraror for review. SECTION 3: FLOODPLAIN DETERMINATION (To be completed by LOCAL .ADMINISTRATOR) Thr, propos, d development is lo,-:accd o❑ F[R1.f Panel No. Dated_ The Proposed Development: 0 Is NOT located in a Special Flood Hazard Arca (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED), CI Is located in a Special Flood Hazard Arca. FIRM zmnc designation is _ 1W-Year flood elevation at the Site E: Ft. NGVD RdSL) ❑ Uoavaalablc ❑ The proposed dcvrlopment is located 1❑ a Ilrodway. FBF-?.t Pancl No [,atcd C7 �cc ;c Ilion a lar a.1dl LUona1 mslrucn..v; SIGNED DATE • n APPLICATION 4 PAGE ) OF a SECT�N?: ADDIT12Nnf- INFORMATIQN RESZUIR o he comnletcd by LOCkL ADhi1NI5T12ATOR) The applicant must submit the documents checked below before the appbcaUon can be processed: 0 A site plan sbowmg the locuuon of all costing slructurCS, water bodies, adjaccot roads, lot dimensions and proposed development. ❑ Development plans,drawn to scale, and specifca pro,including where applicable: details for anchoring structures, proposed elevation of lowest floor(including basement), types of water resistant materials used below the fust floor, details of tloodproolwg of udbtres located below Ute 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 L00-year flood elevations if they arc not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofing protection level (non-resideutial only) Ft.NGVD (MSL). For floodproofed structures, appfican: must attach certification from registered engineer or - architect. ❑ Certification from a registerrJ eogneer that the proposed activity in a regulatory Boodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this Cording must also be submitted- 0 Other. SECTION S: PERMIT DF fERhIINATION (To he completed by L C.4L ADM1t[NISTFLITt�R I have determined that the proposed activity. A. O Is B. f7 Is not in conformance with provisions of Local Law #_. 19`. The permit is issued subject to the conditions attached to and made pan of this permit. Lf 6Q : ?._iL6ckH, the Lncal Admiw,rator may issue a Development Perviit upon Paymeol of designated fer. If B' X B Is checked, the Local Administrator all provide a v.litten summary of debcicncics. Appliulu may revise and resubmit an application to lbc ',lrntnistrwor or may rcyucst a hcarmg from the Board of Appeals. r , APPLICATION a PAkiE I OF I A.PPEALS. .a.ppcalcd to board of Appeals? ❑ Ycs ❑ No Hearing date Appeals Board Decision --- Approved? O Ycs ❑ No Condilioos SECTION 6: AS-BUILT ELEVATIONS (To be s,bmiucd by APPLICANT before Certificate of Comolianee_ is issued The following informadou must be provided for project structures. This section must be completed by a registered professioual engineer or a licensed land surveyor (or attach a certification to this application). Complete I or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: Fr. NGVD (MSL). J L Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL). NOTE: Any w,)rk performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COhiPLL4I`7CE ACT10N (To be comnlctcd by LOCAL ADN1INISTRATORI The LOCAL ADMINISTRATOR will complete this section as applicable based on itupection of the project to ensure compliance with the community's local law for flood damage prevention. INSPP_CTIONS: DATE BY DEFICIENCIES? O YES ❑ NO DATE BY DEFICIENCrES? ❑ YES n NO DATE BY DEFICIENCIES? ❑ YES I7 NO SECTION 6, CERTIFICATE OF OhIPL1AIJ ECTo be completed by LO AL ADMINISTRATOR) Certificate of Compliance issued: DATE BY: 1 . J Attachment B - SAMPLE CEP.TIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZ.AR-D AREA (OWNER MUST RETAIN THIS CERTIFICATE) PRENIISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAL4IE AND ADDRESS: CHECK ONE: 0 NEW BUILDING O EXISTING BUILDING 0 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. CO...'JPLLA.NCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # 19_, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: C /C ( 93 ) o��gUFFO(,f-�O GO x Town Hall,53095 Main Road O Fax(631)765-9502 P.O. Box 1179 y�O! �aO! Telephone(631)765-1802 Southold, New York 11971-0959 J� BUILDING DEPARTMENT TOWN OF SOUTHOLD Fire Inspection Report 2004 July 28, 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 April 13, 2004. Units 1 through 12 are in compliance with the New York State Fire Code as of the above date. If you have any questions please contact me at the above office. Y rs ruly, Robert Fisher Fire Inspector Cc: Chief, Southold Fire Department HeronHarbor-04-07-2 56-0-3.4 Page 1 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REM KS: DATE �� © INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS p 9 FOUNDATION(1ST) — a ------------------------------------- c FOUNDATION(2ND) m 2 O ROUGH FRAMING& PLUMBING Z 5 r INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDTITOT_kL COMMENTS t O z Z m W sme 1 O O r. z x x v m b H 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: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. Check Septic Form N.Y.S.D.E.C. q Trustees Examined ( /� .20 � Contact: Approved , 20_�/ Mail to: Disapproved aic Phone: Expiration ,20 1 Zigor 1 6 AP LICATION FOR BUILDING PERMIT Date Silarfl*6r-z fj , 2004- INSTRUCTIONS 200¢INSTRUCTIONS a. This pplication MUST be completely filled 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 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.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. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing, the extension of the permit for an addition six months, Thereafter,a new permit shall be required. 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) ��A,r- * r7t—�q. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder �-ec�/%�c�,;7— 7— Name Name of owner of premises � o<'� �— /lir 4 L Tz (As on the tax roll or latest deed) If applican is a corporatio �ign�atpure of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which prop sed work will be done: l / 600 ' 7,5' �dyT�OGP House Number Street Hamlet County Tax Map No. 1000 Section S-V� Block 6 Lot Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed consirttction: a. Existing use and occupancy re C_ b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Addition Alteration Repair V Removal Demolition Other Work (Description) 4. Estimated Costa Fee (To be paid on filingtbis application) 5. If dwelling, number of dwelling units____,5— Number of dwelling units on each floor dN a 57-e-4) If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Co Al'or sir 7. Dimensions of existing structures, if any: Front J_( 7 Rear / ( 7 Depth Z u/ Height 116 Number of Stories o a a, Dimensions of same structure with alterations or additions: Front 117 Rear 117 Depth —( Height / Number of Stories o 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front y z Z Rear / 5� Depth 10. Date of Purchase Name of Former Owner 64N �ivv w u 11. Zone or use district in which premises are situated _LE 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NOx 13. Will lot be re-graded? YES_NOXWill excess £11 be removed from premises? YES_NO_ 14. Names of Owner of premises Address Phone No. Name of Architect 7,11" Address ScL,7 L c- Phone No 765-- 5`0'5-5 Name of Contractor Address Phone No. 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. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES_)NO * IF YES, D.E.C. 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 QF sal-rtt+� S7-A?2 „ being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above Ji ed, (S)He is the 06e--e,f1Tec (Contractor,Agent, Corporate 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 beforethi �TN day me of 107tr,d EK 20OLZ Notary Public V Signature of Applicant Barbara A. Stag NOTARY PUBLIC, New York No. 473ppgg Qualified - SuffOlk County Comm. Expires July 31, October 8, 2004 Mr.Gary Fish Building Inspector Town of Southold Main Road Southold, NY 11971 Re: Heron Harbor Suites Southold, New York Building Permit#30636Z Dear Mr. Fish; Please be advised that with regard to the above referenced premises,the Owner undertook"cosmetic refurbishing"in kind and in place of 5 existing motel units which did not constitute a substantial improvement. In doing so he reportedly made every effort to address previously existing non- compliant building code conditions as part of this work. After the work was complete, he requested 1 prepare an as-built drawing which would reflect the existing conditions for the record. The drawing I prepared which accompanied the application for the as-built building permit represents to the best of my knowledge, belief and personal observation the actual construction as it existed on July 2,2004. As such and in my opinion, it appears the work completed substantially meets or exceeds the requirements of the Building Construction Code. If you have any questions, please feel free to contact my office. ED Very truly yours, ��SAl A AS R/rF� c M }I Garrett A. Strang, Architect 015244 .� `STAT f OF NO y�� ®/ �