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Home My WebLink About35972-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34756 Date: 12/27/10 THIS U~KTIFIES that the building EMERGENCY REPAIR Location of Property: 180 PIKE ST MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 141 Block 4 Lot 4 Su]~division Filed Map No. __ Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 14, 2010 purs,,ant to which Building Pel~nit NO. 35972-Z dated OCTOBER 26, 2010 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 EMERGENCY REPAIR TO AN EXISTING COMMERCIAL BUILDING AS APPLIED FOR. The certificate is issued to THE HIGHLANDER GROUP LLC (OWNER) of the aforesaid building. SUFFOLK COUN~"f DEPART~NT OF HEALTH APPROVAL ~T.Rt-£KICAL U~a'rIFICATH NO. PL~ C~RfIFIC_ATION DA'I'~D N/A 35972 12/03/10 N/A ~~Aut~re 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. 35972 Z Date OCTOBER 26, 2010 Permission is hereby granted to: HIGHLANDER (SCHUMACHER) 180 PIKE ST MATTITUCK, NY 11952 for : EMERGENCY REPAIR TO AN EXISTING COMMERCIAL BUILDING AS APPLIED FOR at premises located at 180 PIKE ST County Tax Map No. 473889 Section 141 pursuant to application dated OCTOBER Building Inspector to expire on APRIL MATTITUCK Block 0004 Lot No. 004 14, 2010 and approved by the 26, 2012. Fee $ 250.00 ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANC3 This application must be filled in by typewriter or ink and submitted to the Building Depart A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, stre~ BLDG. DEPT. 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 PI.arming Board Approval of completed site plan requirements. Il. For existing buildings (prior to April 9, 1957) non-conforming rises, or buildings and "pre-existing" land uses: 1. AccUrate survey of pr0perty 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 $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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, Com~nercial $15.00 Date. New Construction: Location of Property: House No. Street Owner or Owners 0f Property: %{J/3 ]3~ yC~,~fX_~[l~r Suffolk County Tax Map No 1000, Section Subdivision Permit No. Health Dept. Approval: 'Planning Board Approval: Old or Pre-existing Building: (check one) Hamlet Block Filed Map. Applicant: Date ofPermit. Lot Underwriters Approval: Request for: Fee Submitted: $ Temporary Certificate Final Certificate: (check one) Applicant Signature To~ l lall Annex 5437,5 Main Il.ad P.O. Box 117!} Southold, N Y 11!(71-09,59 'elcphonc ((;31) 7fi,5-1802 Fax (631) 765-9502 ro.qer.richert~town.southold.n¥.us BI TILl)lNG DEPARTMENT TOWN OF $OUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: The Broken Dow~ Valise Address: 180 Pike St City: Mattituck St: NY Zip: 11952 Building Permit#: 35972 Section: 141 Block: 4 Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE ;ontractor: DBA: Hubbard Elactric LicenseNo: 4709-me SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage Service 1 ph Service 3 ph Main Panel Sub Panel Transformer Disconnect Other Equipment: INVENTORY Hot Water GFCl Recpt NC Condenser Single Recpt NC Blower Range Recpt Appliances Dryer Recpt Switches Twist Lock Ceiling Fixtures ~ HID Fixtures Wall Fixtures ~.~ Smoke Detectors Recessed Fixtures ~ CO Detectors Fluorescent FixturE~ Pumps Emergency Fixture Time Clocks Exit Fixtures [~ TVSS install new meter pan, re-wire bath moms, 2 exhaust fans Notes: Inspector Signature: Date: Dec 3 2010 81-Cert Electrical Compliance Form INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION[ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~,~] ELECTRICAL (FINAL) REMARKS: DATE DATE ['[ '[ ~ [ [ II " [ ~,,.~ FOUNDATION (1ST) ~ ~ ~o~o~ (~) . ~OUOH ~O ~ STA~ ~ CODE / //W~. ~ ~ ~D~ION~ CO~TS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Approved {~/~ ,20 / 0 Disapproved a/c OCT 1 4 2010 BLDG. OEPT. PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health N 4 sets of Building Plans Planning Board approval ~ Survey '7 ~ ~7 Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: APPLICATION FOR BUILDING PERMIT Date 20 INSTRUCTIONS T0W~q OF $0UTH0t0 a. i ms apphcation MUST b~ 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 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. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE RRE INSPECTION REGUIRED BEFORE (Signature of applicant or name, if a corporation) ST^TE' OPENING (Mailing address of applicant) USE IS UNLAWFUL architect, engineer, general contractor,' dlb.~l'rt'~_ t~,~dlhYbL~.~r builder S t~j~,~a~p~a~l~ee, agent, DATE~B.P., ~ vvvv~ ~. ~ ~ . FEE:~O'~°BY ~ ~( NOTIFY BUILDING DEPAR~NT AT Name of owner of premises ,_, ~r~ C ~lln6~ C.~g ~ ........................ (As on the tax roll or lates~{~NG INSPECTIONS: If applicant is a corporation, signature of duly authorized officer ~ (Name and title of corporate officer) Builders License No. Plumbers LicenseNo. Electricians License No. Other Trade's License No. 1. FOUNDATION - TWO REQUIREO FOR POURED CONCRETE 2 ROUGH- FRAMING, PLUI~NG, STRAPPING, ELECTRICAL & CAULKING 3 INSULATION 4 FINAL- CONSTRUCTION & ELECTRICAL MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. Location of land on which propose~t work will be done: House Number Street Hamlet County Tax Map No. 1000 Section / ~ I Block Subdivision Filed Map No. Lot "I Lot 2. State existing use and occupancy of pren)ises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,/? ,/j'/"- b. Intended use and occupancy 3. Nature of work (check which applicable): New Building_ Addition Alteration Repair v/' Removal Demolition ' Other Work '/tgZUJ~'/fo~D( ~'/~ e_.(~'"~.~d, ff~ ! - ~ (Description) 4. Estimated Cost ~'0, ~ Fee (To be paid on filing this application) $. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or ~nixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Height_ Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height_ Number of Stories 8. Dimensions of entire new construction: Front Rear Height Number of Stories 9. Size of lot: Front Rear _Depth .Depth 10. Date of Purchase Name of Former Owner 1 I. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO 13. Will lot be re-graded? YES NO~kVill excess fill be removed from premises? YES NO 14. Names of Owner of premises"~tlDt~ t 5{ ~'lff~LJ//'Address o[ '~ Name of Architect Address Name of Contractor Address Phone No 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 su~ey, to scale, with accurate a, any po,n, on 18. Are thertltmty?Ic~t'hlitl~tncUons with respect to this property? * YES__ · IF YES. PROVIDE A COPY. STATE OF NEW YORK/ ,~ ,,? ¢ . , ', ,i,t '~ ou ,TY N¢¢ WA.I u 8i 38U ']TAOF::I TcL3? rUOHTIW being duly sworn, deposes and says that (s)he is the applicant (Name of individtial signing contract} above named, . L,OI}I~III- t). BUNCH (S)He is the Noia~ Public. State of New York iContractor. Agent, Corporate Officer, etc.) ^ quai~":'~,~',~'~,~n~ bommlssiorl ~xpires April 14, 20 of said owner or owners, and is dulyauthodzed to perform or have performed the said work and to make and file this application; that alPat, atements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed'tn the mahn~r set' forth in the'application filed therewith. 'h -: '~.'"' ~ ~' ,~/" . 'i: Sworn to before me this }G."~ day of ¢::x~.~,~, 20 ! O rqotary Public ' - ~ r Signature of Applicant Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ~ ) I'"(I ('~ I STORM-W~',, =~t, GRADING, DRAINAGE AND EROSION CONTROL PLAN District Section Sl~ck Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. a. What s the Total Ama of the Project Parcels? (thclude Total Area of all Parcels located within 1 Will this Project Retain AJI Storm-Water Rur~Oif the Scope of Work for Proposed Construction) Generated by a Two (2") Inch Rainfall on Site? b. What is the Total Area of Land Cleadng (S.F./Ac~s) (This item will include all run-off created by site clearing and/or construction activities as well as all -- and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? Impervious surfaces.) (S.F. I Ac~s) 2 Does the Site Plan and/or Survey Show AIl proposed PRO~,rl/)E BR]Y~ PROJECT DF-,SCRJl~ION (P,l=Va.,,ad~pag. a.~) Drainage Structures Indicating Size & Location? This Item shall include all Proposed Grade Changes and Slopes Controlling Surface Water Row. 3 Does the Site Plan and/or Survey descdbe the erosion and sediment control practices that will be used to control site erosion and storm water discharges. This item must be maintained throughout the En§re Construction Period. 4 Wild this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving moro than 200 Cubic Yards of Matedal within any Parcel? 5 Will this Applicetion Require Land Disturbing Activities r_.~ ~/// Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the [ ~'~'~ .~/ Site? Is this Project within the Trostees jurisdiction General DEC SWPPp Requirements: or within One Hundred (100') feet of a Wetland or Submicsion of a SWPPP iS required for all Constmcitc~ actlviites involving soil Beach? disturbances of one (1) or mom acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes I'"--'1 V// are Part of a la~ger common picn that will ulrimate~y dict~rb one or more ac~es of icnd; which Exceed Fifteen (15) feet of Verticel Rise to i i including Construction activities involving soil disturbances of ~ss than one (1) ~ where One Hundred (100') of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. ( SWPPP's Shall meet the Mlatm.m Requirements of the SPDES Germml Permit 8 Will Ddveways, Parking Areas or other impervious for Storm Water Discharges from Construction activity - Permit No. GP-O-10.O01.) Surfaces be Sloped to Direct Storm-Water Run-Off 1. The SWPPP shait be prepared prior to the submittal of the NOI. The NOI shall be into and/or in the direction of a Town right-of-way? submitted to the Department [odor to the comme~cemeat of consauction activity. 2. The SWPPP shait describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, / raguimd, post-constmation storm water management practices that w~ be used and~r Removal of Vegetation and/or the Construction of any constructed to reduce the palluisnis in storm water discharges and to assure Item Within the :Town Right-of-Way or Road Shoulder compriance with the terms and conditions of this pan'nit. In addison, the SWPpp shall STATE OF NEWYORK,~.~ ,ff--~0 ~.- ......n .0.:'"u'-'~'L~=mmr~wIY0mUlBU6185050 m ss~0~ I:xpires Apdl 14, 20_L~ That I ................ i'i~,'r~'~'([fi~'~i~'~i';kj[~ii~'~'fiii ................... being duly sworn, deposes and says that he/she is the applicant for Permit, And that he/she is the Owner and/or representative of the Owner ox' Owners, and is duly authorized to perform or have performed the said work and to make and frie this application; that all statements contained in this apphcation are true to the best of his knowledge and belief; and that the work will be performed in the lnanner set forth in the application fried herewith. Sworn to before me this; ~~ ........................ day ~of ...~..~.... ................ ? ...... 20..~..0 FORM - 06/10 'TOWN OF SOUTHOLD i~'ROPERI'Y RECORD CARD LAND FARM TOTAL . DATE DIS~ SUB. /,7,~,~_.Z.' ~'"".~...,_ i · ACR. ' J TYPE OF BUILDING CB. MICS. Mkt. Value 'LOT REA/u~,RKS I0~I' AGE NEW NORMAL FARM Acre Tillable 'Woadland Meadowland BUILDING coNDITION BELOW . ABOVE Value Per V~Jue Acre FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD DOCK ?...e '/' COLOR ExtenSion'.J" ,/2. Y/*/'.- Extension Extension porch Foundation Basement Porch Breezeway Garage Patio Total Ext. Walls Fire Place Type Roof Recreation Room .Dormer . . Floors Interior Rnish Heat R~oorns 1st F~oor Rooms 2nd Floor Driveway Dinette !LR. i BR, FIN. 'Tow~ Hall Annex 5~ Main Ro.~d P.O. Box 117~ SoRthok], ~ 11~1~59 REQUESTED BY: Company Name: Name: License No.: Address: Phone No.: BUILDING DEPAR'I~U~¥F TOWN OF 8OLrI~OI~ ..ApPL CAT ON FOR ELECTRICAL INSPECTION JOBSITE INFORMATION: (*Indicates required information) *Name: "T'~.,,~. *Address: *Cross Street: *Phone No.: .. Pe~it No.: Tax Map District: 1000 Section: ¥~ ~ BIo~: I lqSz- Lot: *BRIEF DESCRIPTION OF WORK (please Print Clearly),.~.. '1~ C ~L~ ~ ~'~ z3~,~L~ T~.~ (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Tamp Certificate: Tamp Information (If needed] *Service Size: 1 Phase *New Service: Re-connect Additional Information: (~/NO Rough In ~ YES ~ 3Phase 100 150 200 300 350 400 Other Underground Number of Meters Change of Se[vice Overhead PAYMENT DUE WITH APPLICATION ~CONT Estab. ID: 3237 Estab. Class: 119 Estab. Name: BROKEN DOWN VALISE iAcf~ Code(s): 12 Inspection Date: 12/10/10 Time oflnspection: 9:37 AM PART 2: BLUE MAINTENANCE ITEMS The~e items relate to maintenance of the food service operation and cleanliness, corrset as scheduled, Other Notes FOLLOW-UP INSPECTION FROM 7/16/10 FIRE AND ANNUAL INSPECTION. ESTABLISHMENT IS PERMITTED TO RE-OPEN FOR SERVICE EFFECTIVE IMMEDIATELY. FIRE DAMAGE WAS CONTAINED TO RESTROOM AREAS, WHICH HAS SINCE BEEN REPAIRED. SUPERVISORY REVIEW OF SINGLE SERVICE RESTRICTION AND MECHANICAL GLASSWASHER RESTRICTION REQUIRED, REMINDER: A HAND WASH SINK BASIN SHALL BE DESIGNATED AT THE BAR, AND WILL BE SUPPLIED WITH HAND SOAP AND PAPER TOWELS AT ALL TIMES. ESTABLISHMENT IS NOT PERMITTED TO SERVE ANY FOODS THAT REQUIRE HANDLING. ELECTRIC PIZZA OVEN AND HOT DOG STEAM TABLE SHALL BE REMOVED. ONLY SERVICE ANIMALS ARE PERMITTED INSIDE THE ESTABLISHMENT. INSPECTION BY ADAM KUEMMEL QUESTIONS CALL 852-595 I \ Person Receiving Report: Sanitarian: 808 KUEMMEL Page 3 of 3