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Home My WebLink About35103-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34080 Date: 11/17/09 THIS CERTIFIES that the building ALTERATIONS Location of Property: 53895 MAIN RD (HOUSE NO.) County Tax Map NO. 473889 Section 61 Subdivision Filed Map No. __ SOUTHOLD (STREET) (HAMLET) Block 1 Lot 18 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 26, 2009 pursuant to which Building Permit No. 35103-Z dated OCTOBER 26, 2009 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 PHARMACY AS APPLIED FOR. The certificate is issued to DB & B CORP of the aforesaid building. ( OWNER ) SUFFOLK COUNTY DEPARTMENT OF HEALTH A~PRO~-AL N/A RLECTRICAL CERTIFICAT~ NO. 11628 09/09/09 pLUMBHP. S c~TIFICATION DA'r~u3 N/A ~ori~ed S'ignature Rev. 1/81 ~orm No. 6 TOWN OF SOOTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION'FOR CERTIFICATE OF OCCUPANCY · This appllcatxou must lye filled m by typewriter or ink and submitted to the Building Department with thc following: · A. For new building or new use: 1. Final survey of prepay with accurate location Of all buildings, property lines, streets, and unusual natural or . topographic featurcs. 2. Final Approval fxom Health Dept. of wa{er supply and sewerage-disposal (S-9 form). · 3. Approval o f electrical installation from Board o f F'lrelUnderwriters. 4. Sw0m statomen~ from plumber certifying that the Solder used in system contains le~s than 2/10 of 1% lead. · 5. Commercial building, indnst.yial building, multiple residences and similar buildings and installations, a certificate ·of Code:Complian~.frcm architect.0i- engineer responsible for the building. . Submit BoX npv o ofoomp!eted sit plan r uirement . "B. For existing buildings (prior to April 9,, 1957) non-conforming nses, 0r bUildings and S'pre-existing~, land nses: . L .~Accurat~urvey~fprepertysh~winga~pr~perty~ine~streets~bui~dingandunusualnatura~rt~pographie-' ' · .features. - ' ' ' ' .2. A properly completed application and c0nsent'to inspeet signed bythe applicant, ff a Certificate of OccupanCy is: denied, the Building [uspeetor shall state the reasons therefor in writing to the applicant. · C. Fees. · - 1. Certificate 6f Of. cupancy - New dwelling $25.005 Additions t0dwelling $25~00, Alterations to dwelling $25.00, Swimming pool $25,00, Acc, es~0ry building $25.00, Additions to accessory building $25.00, Businesses $50.00~ :. 2. CeRificate of Oceapaney on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary ~ertificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: ' Location of Prcl~rty: Old or Pre-existing Building: (ch~k one) House No. Street . Hamlet ~uffolkCountyTaxMapNolOOO, Seetion -- fO { Block Lot i g' ' Subdivision 'Filed Map. Lot: F~t No. r~- ~ Q)'~ Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board ApproVal: .Request for: Temporary Certificate Fee Submitted: $ "~--(~- (~C) Final Certificate: (check one) ^ .cant Signore ~ BUREAU OF ELECTRICITY ~{I J-- 85 JOHN STREET, NEW yORK, NEW YORK 10038 u~s examinea on and found to be in compliance with the require.tents of this Board. SERVIC~ DISCONNECT NO, OF S OTHER APPARATUS: RANGES ;PECIAL REC'PT R TIME CLOCKS BEll. UNIT HEATERS MULTI-OUTLET SYSTEMS V I C E EXHAUST FANS DIMMERS NO OF CC COND & w G NO. OF Hi. LEG A. WG. NO. OF NEUTRALS A.W.G. OF HI.LEG Of N~UTRAL 35 COIlRT </OP~ AGIle;;, NY: GENEIIAL MANAGER Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ~ MANNER. -I- SUFFOLK BUREAU o~ ELECTRICAL INSPECTORS. inc. 40 Nottingham Drive, Middle Island, NY 11953 Telephone: 631 4958136 · Fax:631 9806455 · E-Maih SBEIGS@gmail.com CERTIFICATE OF ELECTRICAL COMPLIANCE Applicant: Rough In Inspection Date: Application No.: Southold Pharmacy November 9,2009 11628 Certificate No.: Final Inspection Date: Building Permit No.: 11628 November 9 ~2009 County Tax Map No.: 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: Donald Scott Site Location: 53895 Hain Road, Southold, NY 11971 Owner's Address (if different): PO Box 1177, [] Residential [] Indoor [] Basement [] Service [] Shed [] Commercial [] Outdoor [] First Floor [] Pool [] Hottub [] New [] Renovation [] Second Floor [] Attic [] Garage [] Addition [] Survey Other: INVENTORY Single Phase Heat Duplex Recpt 8 Ceiling Fixture HID Fixtures Three Phase Hot Water GFCl Recpt Wall Fixture Smoke Main Panel AC Cond Single Recpt Recessed Fixture CO Detect Sub Panel AC Blower Range Recpt Flourescent 6 Pumps Transformer Appliances Dryer Recpt Emergency Time Clock Disconnect Switches 4 Twist Lock Exit Fixtures TVSS GFCI Breaker Heat Pump Electric Heat Poor Luminaire Exhaust Fan Other Equipment: 12 ft of lighting track 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: Southold Pharmacy Inspected By: Roger Richert License No.: n/a Date Of Certificate: Nov 10,2009 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UI~TIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35103 Z Date OCTOBER 26, 2009 Permission is hereby granted to: B & B CORPOPJkTION D MAIN ST - BOX 1177 SOUTHOLD,NY 11971 for : CONSTRUCT AND ALTER EXISTING PHARMACY AS APPLIED FOR. THIS PERMIT REPLACES BP14641. at premises located at 53895 MAIN RD County Tax Map NO. 473889 Section 061 pursuant to application dated OCTOBER Building Inspector to expire on APRIL SOUTHOLD Block 0001 Lot No. 018 26, 2009 and approved by the 26, 2011. Fee $ 100.00 Authorized Signature ORIGINAL Rev. 5/8/02 I~OR,~ NO. 1~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14641 Z Date ....... ..'~.~....../.~ ............... Permission is hereby granted to: ~..~....L!..'a...n ................................................. ~....~..~..,...u..~.~.~ ............ ,o ..~...~...,......~...~.:.~.~.~....~....~~ ~ .............................. ~'";'"';:.i ..................... :'"~i ........ ~'~ .................... at premises located at ..~. ........ 9. ............ ...~.~ ............................................. County To× Map No. 1000 Section ........ ~..~.,/ ..... Block ....... ..~.J. ........ Lot No ..... ]...~. .............. pursuant to application dated ....... ..~.~~....~...~ ....... , 19.~...~., and approved by the Building Inspector. Fee $.Z ..................... Rev. 6/30/80 F1ELD ,INStrUCTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 ' -' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;~ Approved. ~. )..~.., 19 ~.~. merit No../.% .~.l. ~ Disapproved a/c ..................................... ................................ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date....~.... ~.~. ...... 19,51~ INSTRUCTIONS a. This application 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy shall have been granted 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 insp~:ctions. ,,, ,, ..... :.5.o.~..¢~....c3., .P../-k~ .~./... (Signature of applicant, or name, if ~,cor'poration) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ~ ~t4~..~. ...................................................................... Na~ne of owner of premises, x.). {Lt~.~ .~Xt¢...~).~../J~:2..~......v~.~..~J.~.: ............................. (as on the fax roll or latest deed) If appli~n~is a corporation, signat~e of duly authorized officer. ..... (Name and title of corporate officer) Builder's License No ..... .g~/.'~..' .Z-: .............. Plumber's License No ......................... Electrician's License No...~..~..~....~.~.~.ld!'.~. Other Trade's License No ...................... Location of land on which proposed work will be done....~..~?.(<'....~.O ./d....~.~.~./'~..]q~. 4~ .Y .............. ................ ................. ............ House Num her Street Hamlet County Tax Map No. 1000 Section ......... 4 .( ...... Block ....... / .......... Lot ..... ?...~. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. D.~q..~U.A.( ~ .~.....~...~...g.~...../:/~..o..~.. ............................... b. Intended use and occupancy .~. ?.~)?.04 ~....~ ~:'/.57. 3'?.e~.. ~..~!~q.~....."~..4.~.~.../.~...~.. ~]~..O~....~...~. 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration : .~. ...... Repair .............. Removal .............. Demolition .............. Other Work ............... .~/ ~ (Description) 4. Estimated Cost ........ 7.~0.0...'~. .................. Fee ....~9..~.t ........................... · (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .......................................... 6. If business, commercial or mixed occupancy, specify nature and extent o f e'a~'t~e gf'~de' '~ ~)'~.~ ~.' ~ .... 7. Dimensions of existing structures if any: Front .~.* Rear t.~-, 'r~t'h' ' '1 ! ~'/ ....... Height .... 1 .'1( ........Number of Stories...I ...... , Dimensions of same structure with alterations or additions: Front . .~.~..t'~.. ........ Rear. Depth ... ~.. ~·ac.~,.,,d~z .... Height . ~ .......... Number of Stories ~...... ;,. .... Dimensions of ~ hZ~v~'6onstruction Front .~..~ Rear ~'g r~o,,,h ~ 2_ ~ I~ ' e~ght ...c~ ........... Number of Stories .... ('. .................................................. -8. 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ............. 12. Does proposed construction violate any zoning law, ordinance or re~l'aii'o'n':''' ~.~ ......................... 13. Will lot be regraded ...... [[~. ~.. ................. Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ./~ ............... .. {~) f.9.tg,..~.r..4~. [~[-~.... .'... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............................ .0. .... .~...g~...~...~..g.~. ,: g (~.'~. ............................. (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 this ................... OCCUPANCY OR USE! IS UNLAWFUL WITHOUT CERTIRCATE OF OCCUPANCY APPR~V. ED AS NOTED NOTIFY 8U~.DIN~ DEPARTMENT AT 765.18~2 g ~5~ TO · PM FOR THE 2 ROUG~ <.~*,Y~dNG & pLUMBING 0 , ] , C~O-..,~. SEC-F/ON . : ::: < :: ::: t : It II WALL LIM~. -b P blNB v. CALL. R6MCVAL] 0 0 0 x' L_ :~L ~TWAL pETAIL ~-.SLA7 WALL N odiq¥~-p t~'f do ~-TR A,C'TOI% ~t.--AT wA LL- o o II ,% 0 'i o o o i/4"~. I'.c,'l