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HomeMy WebLinkAbout30986-Z FORM NO. 4 ,. TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34226 Date: 03/11/10 THIS CERTIFIES that the building ALTERATION Location of Property: 12150 MAIN RD MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 114 Block 12 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 31, 2005 pursuant to which Building Permit No_ 30986-Z dated MARCH 3, 2005 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 EXISTING STORE FOR MERCANTILE/DELI USE AS APPLIED FOR. (LA TIENDA LTD) The certificate is issued to ANGELINA PROPERTIES LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2052049 04/29/05 PLUMBERS CERTIFICATION DATED N/A Auth razed Signature Rev. 1/81 FoOm No.6 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. — (� New Construction: Old or Pre-existing Building: r (check one) t�f- Location of Property: c� ��t] 1 R n g A M 6- l�CA C C` House No. r ^� Str et —Ha-mlet l Owner or Owners of Property: ,nc,_CI�C A t N P 2 S L L - L Lo- I i,d, L{, Suffolk County Tax Map No 1000, Section , Block Lot a Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: check on Fee Submitted: $ n _ C (­_,-Applicant ggnature FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30904 Date: 05/06/05 THIS CERTIFIES that the building ALTERATION Location of Property: 12150 MAIN RD MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 114 Block 12 Lot 2 Subdivision Filed Map No. Lot NO_ conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 31, 2005 pursuant to which Building Permit No_ 30986-Z dated MARCH 3, 2005 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 ALTERATIONS TO AN EXISTING ICE CREAM SHOP AS APPLIED FOR. The certificate is issued to ANGELINA PROPERTIES LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2052049 04/29/05 PLUMBERS CERTIFICATION DATED N/A i A horized Signature Rev. 1/81 r � n. sly rvo7 60 ?a n I Form No.6 TOWN OF SOUTHOLD I � 2 2005 I 1 BUILDING DEPARTMENT I) TOWN HALL F), DEPT 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. New Construction: Old or Pre-existing Building: (check one) Location of Property: 0G G mn� ry (nil House No. Street Hamlet Owner or Owners of Property: ar��2Y\Q— '1'tvy � h Z3 Suffolk County Tax Map No 1000, Section Block GC i 2 Lot (I©-I— Subdivision- Subdivision _ _____ _Filed Map. Lot: Permit No. Uj U ____Date of Permit. j 3 u 1 Applicant: Health Dept. Approval _ Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 5V co La 3o5oy La C U6 L oq Appli nt ignature 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. 30986 Z Date MARCH 3 , 2005 Permission is hereby granted to : PROPERTIES LLC ANGELINA 1538 UNION TURNPIKE NEW HYDE PARK,NY 11040 for ALTERATIONS TO AN EXISTING UNIT (ICE CREAM SHOP) AS APPLIED FOR at premises located at 12150 MAIN RD MATTITUCK County Tax Map No. 473889 Section 114 Block 0012 Lot No. 002 pursuant to application dated JANUARY 31, 2005 and approved by the Building Inspector to expire on SEPTEMBER 3 , 2006 . Fee $ 200 . 00 (zut ri ORIGINAL Rev. 5/8/02 clsr ri �rPrJc fr1a cP rrJ3frlr�cnrP�rur�cPcnrPrJ��Pr�cnrnrJ�cnr�rl rJ��ncPcncnrJ�r�rJ�cnrJ�r ncnrJ�rJ��nrJ�cnrJ�rJ�n IM BY BY THIS CERTIFICATE OF COMPLIANCE THE e�] NEW YORK BOARD OF FIRE UNDERWRITERS 5 BUREAU OF ELECTRICITY 5 "I 40 FULTON STREET — NEW YORK, NY 10038 5 c5 jCERTIFIES THAT Upon the application of upon premises owned by 5 5 j HUBBARD ELECTRIC TERRY MCSHANE 5 7 178 HUBBARD AVENUE 12130 MAIN ROAD 5 S5RIVERHEAD, NY 11901, MATTITUCK, NY 11952 r� Located at 12130 MAIN ROAD MATTITUCK, NY 11952 5 e5 Application Number: 2052049 Certificate Number: 2052049 5 Section: Block: Lot: Building Permit: BDC: nsl1 c7 5 Described as a Commercial occupancy, wherein the premises electrical system consisting of � electrical devices and wiring, described below, located in/on the premises at: S5 5 First Floor, `] 5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard 5 promulgated by the State of New York, Deqq rtment of State CoP �forcement and Administration, or other �5 authority having jurisdiction, and found to be t ompliance the }Hfg the Day of Name OTY Rate Rating Circuit Type L5 Miscellaneous 5 Slights&recpticles in hallway 5 5 and furnace room 5 SWiring and Devices Fixture 1 0 Flourescent 5 5 5 Fixture 5 0 Incandescent 5 Receptacle 4 0 General Purpose 5 5 Switch 1 0 General Purpose 5 Miscellaneous 7 5 5 Commercial Inspection Fee 5 5 5 seal 5 5 1 of I 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 D r 9 cfr�cP rJ� rJ�rJ� rPrJ�rP rrurJ� cP rJ�cnrrurJ�CP M I! li Fill cnrJ�rJ�cn c ncPr�r lcJ�rJ�cnrJ� O 1 ��- i-rf-'/ --)c-i j2-- 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND �[ ] INSULATION FRAMING C�TCT/o/ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: � � ""'� "�;/ L4— Ca DATE INSPECTOR ''�- 3o7y (,, z 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE . �- INSPECTOR TOWN SOF SOUTHOLD PROPERTY a a - OWNER -- �. STREET RECORD CARD Z 5 VILLA C� DIST) SUB. LOT FO ER OWNER IN Mp !`i i i a c; K , , 58 l l(^ex I f2ec� e E ACR. D'S. VL. TYPE OF BUILDING R Td SEAS. FARM COMM CB. MICS. Mkt. Value LAND IMP. TOTAL QATE REMARKS ca l3 �@7p 2cic �G � d J 3odo isob0 �.:ihy7f Z 7 f-P w o v a d ZA .� , -4n Grp- � 9a6 - q3 ,?# . r - Coin-toy >at� as s -i2�0 fea 1Nciap AGE BUILDING CONDITIONelin��Sp,DOD NEWS NORMAL BELOW ABOVE FARM Acre Value Per Value - - Acre Tillable Woodland FRONTAGE ON WATER I FRONTAGE ON ROAD Meadowland � ;✓ c2 .` v PTH House plot DEPTH Total AOI 0I BULKHEAD DOCK ®®■■■sem■sa■■■■si ■■■■■e■ e■ CuM■■■■■■■■■■■■■■■n S ENO O■■■NOMMEN■...■■ WE _IN ■NEE■■■N■■■M■■M■�1 • NN■■■■■■■■■MEN■MEN■ NNEE■R■l MMOMM■■■On■■■ on ■ME■EousEMEEE O�EEE s=EM�ion ■■ ski MEE■■E■ O■E■`'�7 ■■■■ ■N ■■O■ ■■MEMOS■■■■■■■■■■■■■ ■■■� ■MM■OM■■N■■■O■M■■■■■■■ ■ Y�■�■■■■ME ■■■■■■MEMMEN IN ■■■■ ■ c • • NN■■\■M■■MIMMENJURI. ME OMERMI NOON■■■N NN■■■N■■■M�siisEE � ININ Noff :. .. Ext. Wallsci jTpe •.. .. Roo s2n. .. FIELD INSPECTION REPORT DATE COMMENTS W FOUNDATION (1ST) -------------------------------------- FOUNDATION -----------------------------------FOUNDATION (2ND) -6=o v� ROUGH FRAMING& PLUMBING y INSULATION PER N.Y. H STATE ENERGY CODE - - - - - - - - vs- FINAL ADDITIONAL COMMENTS -_ - z m m -fl ro J' iS' o m - � x d ro y TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN 14ALL Board of Health SOUTHOLD, NY 11971 '-4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 --$urvey www. northfork.net/Southold/ PERMIT NO. �()Jr�'6 '� Check Septic Form N.Y.S.D.EC. / Trustees_ Examined ,20 Contact: Approved `f Z 20 Mail to: Disapproved a/c_ ?0 - � i Phone: C it _ 2wb o416 Expiration � , 20_A� A ui Spector .IAN 3 1 Oa APPLICATION FOR BUILDING PERMIT Date )c,ru,),, \ 20 W INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 hispector 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. (Signa" rre of applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder _Lrsae �-- Name of owner of premises 1) 1%pr, L (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. � ntAin� Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: I'LIN 111wr� Renck (11 4� C1L House Number Street Hamlet ���;?;3aIP t1�f>A�A� County Tax Map No. 1000 Section 1\y *'3T*�j;eL"JtL!'V"000 Lot Subdivision tizug N 1oP16a _ Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructions a. Existing use and occupancy Z�. e C r2 oo I'\ 1 hc'�. b. Intended use and occupancy K c e C v�c,m Sho 3. Nature of work (check which applicable): New Building Addition Alteration ✓ Repair_ Removal Demolition Other Work (Description) 4. Estimated Cost 2,t;Cx*w Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units C� Number of dwelling units on each floor U If garage, number of cars r; 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. �e�Crew. Shue 7. Dimensions of existing structures, if any: Front ZC Rear Zu Depth__%0 Height Number of Stories l Dimensions of same structure with alterations or additions: Front 10 Rear ZO Depth U-) Height Number of Stories_____L_ 8. Dimensions of entire new construction: Front 5P,rA, Rear Depth Height Number of Stories 9. Size of lot: Front IUU Rear ICC Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated A k� 12. Does proposed construction violate any zoning law, ordinance or regulation? YES N01—/ 13. Will lot be re-graded? YES NO_Z Will excess fill be removed from premises? YES_NOV 14. Names of Owner of premises Rni)el%Na?yQ.auhuLSAddress t53f L1n�n�TpK,"b N p hone No. 5'��`��' 6Sota Name of Architect t .ltd Ee ler Address thp0 fi. K Phone No 1l)bao 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 OF S u f(c))L TP v r a nre. D being duly swom, deposes and says that (s)he is the applicant (Name of individual signing contract)above named, (S)He is the L C' 'i SCC (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 before me thi ?/ sk day of Gt r7u 20 e -3 Notary P blic ignature of Applicant Nfty ha NUN 1 Awyak QwWdd In CxMis"Em"kewis;2007 i, 2 20 OF 0 Ll