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Home My WebLink About32598-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date, 02/16/07 No, Z-32202 THIS CERTIFIES that the building ALTERATION (STREET) Block 11 MATTI TUCK (HAMLET) Location of Property' 13520 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 114 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 15, 2006 pursuant to which Building Permit No. 32598-Z dated DECEMBER 27, 2006 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 ALTER EXISTING RETAIL SPACE TO A DINING ROOM TO INCORPORATE INTO AN EXISTING RESTAURANT AS APPLIED FOR. The certificate is issued to JOSEPH & BETTY A HARDY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 4196 01/28/07 PLUMBERS CERTIFICATION DATED 12/28/06 HARDY PLUMBING & HEATING ~"~'""' Rev. 1/81 IB I 6 ?:, Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~. 1&5'1 cp- 39 ~~i:r.-, II- ~ ' If Ho r- 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 2/1 0 of I % 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: I. 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 Certiticate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. F ces I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy ofCertiticate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date <-:)- ILl - () 7 New Construction: Old or Pre-existing Building: X (check one) Location of Property J3t;,)O NI/~IN KD, )\;\I\i\\\UGKi N.~, House No. Street! Hamlet Owner or Owners of Property: 0 0::) E ~ H- ~ 15 0 IT 'I A" +1~ R \::, '-J Suffolk County Tax Map No 1000, Section [ } '-t Block C D I l Lot 0 D 5 Subdivision Filed Map. Lf 73 g g 9_ Lot: Permit No. 325q xZ Date of Permit. /2--21-0(, Applicant: .JcsE'Pt+ 7' Bt;rryA,HH/\'SJj Health Dept. Approval: Underwriters Approval: I' 20.2.001 Planning Board Approval: .../ (check one) Request for: Temporary Certiticate __ DC- l--. " ...-- Fee Submitted: $ :d U Final Certiticate: i~' 71S'if Co ~3[).J D;L ~st~ 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. 32598 Z Date DECEMBER 27, 2006 Permission is hereby granted to: JOSEPH & BETTY A HARDY 1654 COUNTY ROAD 39 SOUTHAMPTON,NY 11968 for : ALTER EXISTING RETAIL SPACE TO A DINING ROOM TO INCORPORATE INTO AN EXISTING RESTAURANT AS APPLIED FOR. WAIVER FROM PLANNING BD 2/6/96 BP# 23244 at premises located at 13520 MAIN RD MATTI TUCK County Tax Map No. 473889 Section 114 Block 0011 Lot No. 005 pursuant to application dated DECEMBER 15, 2006 and approved by the Building Inspector to expire on JUNE 27, 2008. Fee $ 200.00 /} . ~ V;;E~__L'" " Authorized Signature ORIGINAL Rev. 5/8/02 SUFFOLK 3;).59 t BUREAU,,' 1_ 1_ Lei f~ ! C 1\ i. iNSPt-.CTOFS, 40 Nottingham Drive, Middle Island, NY 11953 Telephone: 6314958136. Fax: 631 980 6455 . E-Mail: SBEIGS@gmail.com CERTIFICATE OF ELECTRICAL COMPUANCE Applicant: Two Gang Electric Rough In Inspection Date: 1/20/2007 Application NO: 4196 Suffolk County Tax Map NO: 114 11 5 Final Inspection Date: 1/20/2007 Certificate NO: 4196 Building Permit NO: 32598 This Certificate of Electrical Compliance is limited to the inspection and compliance of electrical equipment and/or work described below, installed by the applicant named above, located at the premise of and not after the final inspection date above: Owner: Hardy Address: 13500 Main Road, Mattituck, NY 11952 Address of Inspection Site: 13500 Main Road, Mattituck, NY 11952 Residential X Commercial New Addition Service 10 Service 30 Main Panel Sub- Panel Disconnects Transformers Twist Lock X Indoors Outdoors Renovation Survey Heat Time Clock Hot Water GFCI Breaker Dryer Recpt 1 Exhaust Fan TVSS Other Equipment: 1-Refrigerator Cooler Basement X 1st Floor 2nd Floor Attic Inventory 9 Duplex Recpt 8 Switches GFCI Recpt Single Recpt Range Recpt Appliance Heat Pump Service Pool Hot tub Garage Shed Other: 5 Ceiling Fix Wall Fix 16 Recessed Fix 2 Fluorescent Fix A/C Blower A/C Cond Electric Heat HID Fix Smoke Det Co Det Pump 1 Emergency Fix 2 Exit Fix Pool Luminaire The electrical work and/or equipment described above were inspected and appear to be in compliance with local, state and national electrical code requirements and this office. Applicant: Two Gang Electric Inspected by: J Hne R Surdi Signature: ~ License No: 4693-ME Date of Certificate: 1/28/2007 3).S1lf TEL. 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWN HALL SOUTHOLD, NY 11971 CERTIFICATION 3 2!;q g Z Date: aj281o(o Building Permit No. 2:31. L\ J, - Owner: 2ICF...Y?O<\ ~Cl,6-~ (please print) \ Plumber: Hardv Plumbing. Heating & Air Conditionina. Inc. (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1 % lead. I also certify that I installed an anti-scold and/or thermal shock preventing device at all bathing and/or showering fixtures in conformance with part 902.6(k) of the N.Y.s.F.P.A.B.C. K\r\c ~,>> (plumber's signature) Sworn to before me this . / ~aYOf 'D~~ , 2000 Notary PublicI ~FFfJ-K- County ~ (Notary Public) JOANN BARONE Notary Public. State Of New York No. 01 BA6087016 Qualified In Suffolk County 01 Commission Expires 02110/20 _ ~ '-!' ~ yL/l{-r TOWN OF SOUTHOLD PROPERTY RECORD CARD ...J /000 - //;-/ ~ //-s OWNER STREET :7,. ")0 "'--./ <.--) L- VILLAGE DIST. SUB. fin - ;.1, 'i ~ LOT J~~LHr.tyJ, . FORMER OWNER .7('1 \.1Y'd ~~~~_~wJ_LUQ I p , } ,.' ~ /t (t / I '. i '..t ~_. !u r AC~ ,C:;o 1 TYPE.OF BU.ILDING _m.... ....m... / 1"$. ?- ?7!i--- - -- - ---- -- _ __ m ___ --un ____ _ __ _ ________.. _ TOTAL DATE E C/A.l17107 e.. . .. ..~ \ I bC7P):\~k-Ghr> (COMM~/CB. MICS., Mkt. Value REMARKS rrJ f./),,~ 5 Ik~, ') . /{J'~. FARM RES. 9'F5 SEAS, LAND IMP. VL. 00 ~ILDING CONDITION a;t~ y /C<slt"".! f. .. Sf,,(" kO;Jl'd5 10 Cia...h"'T1a:>1e.. L Zakv<1' -'I c:;,S 000 v;".f- ~ . ;t.~D.Q()D l- I c:c..... $' 5LlOU, .' W ':' ' , I-fc yd'l - 38C;;~.cL'C) -- . . -;.7 6'/):'jY~'-'H/L;':>~_ . J\'" /1 3,90 _ '#= ~'t. E,.)<.',sfc ?:'/...7..a.~)o..V1m'--~'3,0(JI( II ;i \'l,ll.97C " .,i" \ . fT 10' BP 19'/-'tlS"- ReJ>JoC'P -#.j~Q_!L't-) ~ J \. : J / ~(31oLj(...l T l.!30lA-,1'1 <,e ) It, /'J;}.o '11- Bp# ao.,a ?IS:- CnY1s..:!-.... ALte.....~Vl 90... Refa', 15-1o~p .';l"oon. o ,. I"'!'( l .s~, (lr9'j".7' ~ c. C ...;>.50 c) Ii'P DC. ..::J.. 0 /-200 to () _I- iI-'-' _L'c 0 0 00 AGE ..] T - ?/I 0 t 0 NEW NORMAL BELOW ABOVE .;J 14}12- Bp.1F~()"'13() - l1/kvaftOt1s +D OC~S5:0(L(hldj F"C 300 FARM Acre Value Per Value .217-0/~ ~- f2.evl-e~c1 N/~ Acre iIIable FRONTAGE ON WATER aadland FRONTAGE ON ROAD / v ' ~ . . /7(' i', v' (,:;1 , L_ J. r; ,-- ,.-. - - eadowland DEPTH fli! 3].5 , ause Plot BULKHEAD - atal "", ,.....-. DOCK ...... W M H T J , ;, - 1/ COLOR 3 "- + TRIM ~ ~ ~ / M. Bldg. , . "" Interior Finish ( i>"'''A?tS) ",~>(" 'I' /9'/"1 I ,.of::. !ll () S- J( I:l. I, d.> Extension 1--- ~ s5.3S ./ Extension .;: Extension L-"),- ';:w. sf ': / ~',,, C (3 - 3~'~1\ Bath Floors 'I' .,,":0,' t .~ Porch Basement P'I \.1 Porch l,A.) J.; Ext. Walls .~ " Breezeway Fire Place " , Heat ,)),) ., pe Roof Roams 1 st Floor Room Roams 2nd Floor I i O. B. o ~o''':' ." Driveway Total o / o 55'-1 1010 &.f.or,::>r,,~c$ f3J7k:>' 3hJ 4/2,(P<;;0 ~ -d 5 5lf.~ ~I r ,. ; ,-. '> II I 1- v.. ....t? P /,~ "- LV f.) ~.l It.-I:..... f:', ~~--- I [ I J '9 Dinette K. lR. DR. BR. FIN. B ~ PLANNING BOARD MEMBERS RICHARD G. WARD Chairman GEORGE RITCHIE LATHAM, JR. BENNETT ORLOWSKI, JR. WILLIAM J. CREMERS KENNETH L. EDWARDS ~ ~~ :::> '""'li Q - "'" '"" ~ J:! ~. "'"~ ~Q.f + "1-~~ Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-3136 Telephone (516) 765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD "--..'. R ~ ~ JJiJt. tJr-'" . FEB 6 \995 February 6, 1996 ~,-_..,-~..-~_._---:~.---_. r:,r-o , 1,...01._-' .,.,-...\t,.I~, ~:.:X Angelo Toscano Mattituck Village Pizza 13550 Main Road, Mattituck, NY 11952 RE: Mattituck Village Pizza Main Road, Mattituck SCTM# 1000-114-11-5 Dear Mr. Toscano, The Planning Board has received your letter of January 24, 1996, requesting a waiver of site plan requirements for your proposed expansion to the middle store at Hardy Plumbing and Heating. The Board reviewed your floor plan, sign sketch, and parking requirements included with your letter and finds them acceptable. As indicated in your letter, you will have the required amount of parking in the rear area in addition to a rear entrance. Additionally, a wall sign and two additional information signs will direct customers to the rear parking area. Therefore, in response to your request, the Board grants a waiver of site plan requirements for your business expansion. If you have any questions, or require further information, please contact this office. ;,ere ~a d G. Chairman cc: Thomas Fisher, Senior Building Inspector 3)5Cjg- ARCH ITECNOLOGIES ARCIII11!CroRI! Pl.ANNING CONSTlUlC'l1ON SBRVICBS 13405_-'-' _Ven U9S2 631.2!l1l.1129 r..: 631.2!l1l.1128 December27,2006 Town of Southold Building Dept. Southold, N.Y. Re: Mr. Joseph Hardy 1654 North Highway Southampton, N.Y. 11968 BP#: 23244' f-t. ",e.w'll :# 3J-S-~ g L 13520 Route 25, Matlituck SCTM: 1000 114 0011 5 To Whom It May Concern: Mr. Frank Notaro has inspected and certifies the compliance of fire separation between occupancies, the following was noted upon inspection: The demising partition between occupancies consisted of full height 10" block wall to underside of roof above, 2" x 4" wood construction wall on either side of block wall with 1/2" sheetrock 6" above the existing acoustical suspension ceiling. ~ \ , \ tt\1 - '2. "-.-;-) ~ LLM,z P24k Y 3J.5:qp TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/STRAPPING ~NAL [ ] FIREPLACE & CHIMNEY ~E SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION DATE Z - I ~ -0 7 INSPECTOR f' I El.1I III:;I",C [[Oil IU';['OIlT U!,TL' .. . _ .m _. '.. ~. '''~~~''~~~"'~~_~~~t!t.!~!!l~i~~",,,",",''=",_''__=__'''' :-:,.:.=..~====m"-""=-=h'I:~~-::]!""---"--'--";- .........____...... ... ......... 1(1I 1111 '^T 1011 (1:;1) ~-----II /JR... ~~.::.~-_~~'~__:'.~:~.:': II ---........11. ... --......-. II ....11 .. " "'f//ff . -------1/-------.. -._-- _mumd. ----..-------....-... ~ "",!!!'"____ll"'l______, ~~-~~~~--~~-----~-.. < IWIli:1I FIlMII' 6 I I-~u.. . L;-~.:x; 2ii> 0 """"'"" ,:.-..IL~.. --~-~~~ ~ --===-===--===--====--=== .~:~~=rr=~=====~=-= ==~~~~::~~~==~~~=~-:~ I ~~~~::'II~---:~:' --iI--- I -------- ..ll--.-.---#;Ir- ....... ._____ j II II=~~~~:"II =~~~~--~::---.::'.:" .._-----__-_~~~___~~=__~:~~:~:=~==~---- ~ ----------.-------------- ~,;;;~~::.-~~_.~::::::;-~:-~-_.~-,._--:--~_.: ~ jj 11---1~4 'Ju ~..~~... f FIII^1. --------F~----.~-----..- ~~ .~ II---n---- ll.lhisl-.L -- ---CL.~_ .~ & ~ =-=~~=--==--=--=-=_==____[__=_=___Il~-~=~---- _ __ =~~_===. 0 ~~ ==~ ..~--== ==------....--..------....- .../!.".. ..---.. .....~~~~~~~~~~_~~~~!~~l~ ~-=-.._..__=__._..===_=== ..= =. ~ O~ ..lil!i1~~.--~_tPo~1R~~~~~~~....~2t--2.~~_~~~ ~ 1--------------.Allii:Z-- .-.--~-~-~u,q'~-I--.-0L '- " ,0 ~j: .~----------~-n~n--~~ --~.--- \7r - ~ -.'b.1....t -E- --. .. - "'.~_n.k_u''fj__u___.. - ~1t.-<<-~--.- ~?~li~:;-Z_~~~~~Jv;,(;~~~.:;~~-.:~~?~_~2:~~_~..~=~._~:~.==~~--=-:~L:.f,L~=.~ .... ..--- --------.--_..___~..-::..n._~ '?"._m.~.Q._ __.._.. .____ __u_ ..__.m_____~__..__________ I N~all,^,r 1011 PElt tl. Y. S'lAm Etllml';Y COlli, . .... - . - .....- .-..----. .--______._.___ ..a_________. r '-X ,~' '" ~ ('1" ~-S::J ,( '>-.l... H '......""-) .., ~I f ,., ;p .:::t. ...~ 1'1 tj ~ ---- , ~. ~ H- H ~ o VX z '11 (" ". c' ~I CJ (>1 "J ., .FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN IIALL SOUTII01.1I, N.Y. '1971 TEL: 765- 1802 ,.... 3 SETS OF PLANS ..........,.... JIl SURVEY ....,.....,............. ,.... ClmCK ......................... SEPTIC FORM ................... NOTIFY: ~ 19-- 0'=' CALL ..':;), f f. . :: f] .7['[:) . BLDG. DEPT. T"WN OF SOllTHO' n Exani~: :4.1:.. ..~., Approved......~~~....:, Disapproved ale....:............................. '9.9.~ 19~9/P MAIl. TO:.................... Permit tb. .)}:~~ ~ri;:. . a .. .. ~ .. , .. . . . . . . . . . . . . . . . . . . . . . . .. .. .. .. .. .. ...................................... ............................................................. ......~~: o:..I~.. (Ouilding ~~tor) APPLICATION FOR BUUDING PERMIT .. lIa te . . . . . . . . . . . . . . . . , 19 . . . . INSTRUCTIONS a. This applicatioo nust be COI1'letely filled in by typewriter or in ink and IlUbnitted to the D.lilding Inspector with 3 sets of plms, accurate plot plm to scale. Fee acmming to schedule. b. Plot plm Ilhowing locatioo of lot and of buildings 00 premises, relatiooship to adjoining prenises or public streets or areas, and giving a detailed description of layout of property nust be drawn 00 the diagr... "',ich is part of this applicatioo. c. The 1lUI:k cOvered by this applicatioo 1m}' rot be """,."...,.] before issuance of Ouilding Permit. d. Upon ~1'l"UY..J. of this applicatioo, tile Ouilding Inspector will issue a Ouilding Permit to the applicaot. Such permit shall be kept 00 the premises available fur inspection throughoot tile work. e. tb building shall be occupied or used in """Ie or in part fur any purpose ""atever until a Certificate of. Occupaocy shall havt! been granted by tile fuilding Inspector. APPLICATICfl IS mmJY .wE to the Ouilding JJepartJrent fur the issuance of a fuilding Permit purllUllUt to the Ouilding Zone Ordinance of the 100m of Soothold, !hffolk County, New York, and other applicable Laws, Ordinances.or Regulatioos, fur tile constructioo of buildings, additioos or alteratioos, or for remval or demlitioo, as llerein described. The applicaot agrees to COI1'ly with all applicable laws, ordinances, !Jo,ilding code, housing code, and regulatioos, and to ainit authorized inspectors 00 prenises and in building fi~n?t;nn~ --, . . ~:;t~{~~~:.~.~~~.~~~~i~). . gkflI/AQ.f~J:I. .~~..5f/i /.{.1t~y' 11)1;.167- (Mailing address of applicmt) 1" State "'lether applicaot is owner, lessee, agent, architect, engineer, general cootractor, electrician, plUtber or builder. .-l;;fJ.IlJ.../, ~3.f!A-:.r..... (;.f'd'Jt:/;::t1.t.. .L.o.lJ. (iir1.r:i!f................................................. N;m, of owner of prenises ...~.t?:.. :k.. f3.r;;.~... .f;'I1.t;;.t.>. ("...... .................... ... .......... (as 00 tile tax roll or'"i~test deed) <:r If al'plicaot is a UJ'I",ratioo, signature of duly authori..ed officer. /!.ti.G: Ii/: (.2... .!.05r.fllf.P..... (f1f:tB:P?10 (N;m, and title of corporate officer) Ouilders License tb. PlUtbers Ucense tb. -_.~ .....~.:..:."..:.,.,-""... Electricians License tb. .. ,......;..::.:-:...... :::~___ OOler Trade's License tb. .. .-:................ I. Location of land on which proposed work will be dooe.......;:.~.~~~....................................... .............................................. .;21fJ.i.tJ..~.... $&.l1J};ZC. /:/ t(.............. Hoose Ibrber . Street Hamlet /. . County Tax Map tb. IlXXl Sectioo .., /I!t.:.... Block .../1:........ Lot ..Q .5........ Subdivisioo ...................................... Filed Map tb. ............... Lot ............... (N;m, ) 2. State existing use and occupaocy of premises and intended use and occupaocy of I'W~ coostruction: a. Existing use and occupaocy ..... ./6.............................................:..:................, b. Intended use..:n occupaocy ......(6.,................................................................. \ 0-' J. Nan"e of work (dleCk .,hid. applicable); Repair ...........,. ~al ..,.....t....... -- " New llo.,JiJding .......... Additioo .....(... Alreratioo .~....... Ileunh tloo ............ Other Ibrk .. .. ..~ .. .. . . .. .. .. . . !Descrlptioo) 4. ~ '\'Ie At> Ilstimated Coat ..f. f::.Y.l...~ .pN'//;'ftk1 fee ................................................... (to be paid 00 filing this applicatioo) 5. If OOelllng. nwj",r of dwelling IHlits ............ Ihl.",r of ,1"'lIing IHlits on eadl f1~............ '_ ---------- If garage. hllfler of cars ........~....................... 6. If hllSiness, caw",rcial pr milled occupancy, specify nature and extent of eadl type of use...,-f:?;;7.r.f,,<.... 7, DiUJenaions of existing structures, if any: Froot.........,...... Rear ............... Depth ................. lIei81.t .... 9.{ r.:.r. .. .. . . . .. . lhdler of Stories .. /;j;). . .. . . . . . . . . . . Dimensions 0 aane 6tnJCture with alteraeioos or additions: Front ............... Rear ................ Depth .................... lIei81.t .................... Ib,.",r of Stories ............... 8. Dimensions of entire new constmctloo: l'root ~_r~-.-,.~o..'llear .,-:-............ lJeptll~':.:..... lleight .............................. t....,.... t...... llDfler of Stories ...................................... 9. Size of lot: Front......,............. Rear .................... Depth .. .. .. .. .. .. .. .. .. .. .. .. .. .. 0"" .. .. .. ~ 10. Oate of PurcllSse ....,.............,.. Nane of Former OoIner ....................., .,...........,..... II. Zale or use district in ....id. premises are siruated I..'.......................................................... 12. Ones proposed constnlCtioo violate any zoning law, ordinaoce or regulatioo: .........,.............. 14. n. Will lot be regraded .................... Will excess fill 00 rflOOlled trau premises: YIlS m Nallles of OoIner of premises .,......................... Address .............................. Phone lb. t'Ir.:Ine of Ardlitect , ~..... t "1" ~ ~ t..... ~,," 01"..... ~...... ~...".... Mlres8 .......................".. ~........................ FtWXle ltl. Nane of Contractor ,.................................. Address ............................. ..Phone lb. 15. ,Is this properly within JIX) feet of a tidal ""tland? * YIlS .......... m.......... *11' YIlS. In1IllID 'IlUI11l11S1l!l!S ~I'J' Ml\Y HIl RIllpIIlJ!O. .............. .............. .............. 1'1.01' DIAGRAM locate clearly and distlncUy all buildings, wlether existing or proposed, and indicate !Ill set-back djlllensioos from property lines. Give street and block lUlber or descriptioo according to deed, and show street ll8Il1eS and indicate \A~lher intecio[' or corner lot.. S1'A1'Il OF NIlI~ YORK, COUNTY OF .3'1P:ffo.~...... ......ANc;;.JP.....'~.sf!..ll.tJ.r)............... \",ing ,l.ly sworn, deposes and says that he is the applicant (Ib", of individual ~Igning C<J<l~rl!(;~) al~ oared, . Pf, lie )s the..... .......C~p..,..a... ..~.. ..... ........................................ ........ ..,............ (C.ootractor, agent, corporate officer, etc.) of said woer or OWllers and Is dJly' authorized to perform or hlJl/e performed the said work and to make ard file this ' . f applicatioo; that all statements cootained in this applicatioo are tme to the \",st of his knowledge and oo11e j and Ihat the work will 00 performed In the manner set fortll In the applicatioo filed therewith. SS ~m to before ~is ..... .....:!.t....". .....,,,,.... ~il~~{tw~~'"'''''' It)tary I\Jblic ~~ Neo~UBllC, State of t~:t y , , --}'f.-;Jj;;j."'L'.'......"~ 'f~ ---....J.lo. f,y- ,jr;",:l4:-:- Q alifjed in Suffolk County "------...)~ Oti:::.'on Exp;,,, Nov, 30,'19 ?::i~::, . ~ .::> .................. ........,........ "f ;11,,,1 ir ",t' SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CERTIFICATE OF APPROVAL OF FOOD SERVICE ESTABLISHMENT FOR CONSTRUCTION, ALTERATION OR REMODELING Applicant Establishment Location Mattituck Village Pizza 13550 Main Road Mattituck Approval is issued under the provisions of Article 13, Section 1304 of the Suffolk County Sanitary Code for: I) New Stmcture 3) Conversion 2) x Remodeling. 4) Other THE FOLLOWING CONDITIONS APPLY: 1) THAT THE PROPOSED CONSTRUCTION BE IN CONFORMITY WITH THE PLANS AND SPECIFICATIONS APPROVED BY THIS DEPARTMENT. 2) THAT THE APPLICANT CONTACT THE APPROPRIATE DISTRICT OFFICE OF THE FOOD CONTROL UNIT PRIOR TO OPERATION OF THE ESTABLISHMENT TO ARRANGE AN INSPECTION OF COMPLETED CONSTRUCTION. THIS CERTIFICATE IS NOT A PERMIT TO OPERATE A FOOD SERVICE ESTABLISHMENT. OPERATION WITHOUT A SATISFACTORY PRE- OPERATIONAL INSPECTION AND/OR A PERMIT TO OPERATE WILL RESULT IN LEGAL ACTION. 3) THAT THE APPLICANT SHALL ASSURE CONFORMANCE WITH THE FOLLOWING AMENDMENTS TO PLANS AND SPECIFICATIONS: 1. Water heater shall be a minimum of 50 gallons storage with 66,000 BTU's. 2. Dough mixer shall have an accessible hand sink. Entry to cubicle (with mixer and floor pallet) shall be widened to approximately 5 feet or hand sink located near mixer. . ISSUED FOR THE COMMISSIONER OF HEALTH 7 . /;7 a./l ~ " -/ OJu /( 1 23 96 " ESIGNATED REPRESENTATIVE DATE TRAINING AND PLAN REVIEW UNIT 1700 UNION BL VD. ROOM 106 BAY SHORE, NEW YORK 11706 854-04 II