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Home My WebLink About36877-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 4/24/2012 CERTIFICATE OF OCCUPANCY No: 35559 Date: 4/24/2012 THIS CERTIFIES that the building ALTERATION Location of Propel'W: 57995 Route 25, Southold, SCTM #: 473889 Sec/Block/Lot: 55.-6-34 Subdivision: Filed Map No. conforms substantially to the Application for Building Permit heretofore 12/8/2011 pursuant to which Building Permit No. Lot No. filed in this officed dated 36877 dated 12/20/2011 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: renovation of existing farmstand (doorway) as applied for The certificate is issued to Polak, Kevin & Polak, Donna (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 36877 1/27/12 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 36877 Date: 12/20/2011 Permission is hereby granted to: Polak, Kevin & Polak, Donna 55 Fanning Blvd Riverhead, NY 11901 To: renovation of existing farmstand (doorway) as applied for At premises located at: 57995 Route 25, Southold SCTM # 473889 Sec/Block/Lot # 55.-6-34 Pursuant to application dated To expire on 6/2012013. Fees: 12/8/2011 and approved by the Building Inspector. FARM BUILDING ALTERATIONS CO - ACCESSORY BUILDING Total: $150.00 $50.00 $200.00 Building Inspector Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ]'his 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 frown 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 buildiug, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engiueer responsible for the building. 6. Submit Planning Board Approval of completed site plan requiremeuts. 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 aud unusual natural or topographic features. 2. A properly completed applicatioa aad coaseat to inspect sigaed by the applicant. Ifa Certificate of Occupancy is deaied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees I. Certificate of Occupancy - New dwelliag $50.00, Additions to dwelling $50.00, Alteratioas 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-existiug Building- $100.00 3. Copy of Certificate ofOccupaacy - $.25 4. Updated Certificate of Occupancy- $~,0.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Ne,a, Construction: Old or Pre-existing Building: Location of Property: ,5'"~ ~q--[~' /o/,/'~)'d~t) /~'~. House No. Street ()wrier or Owners of Property: ~'~'[///~ ~t~ ~ ~..,v/'U' ~c Suffolk County Tax Map No 1000, Section t'lg.~z~oC~ ~_5'5- Subdivision Permit No. ,3 ~ 777 Date of Permit./c2 -,9,,~ - l / Date. (check one) Hamlet Block 6 Lot Filed Map. Lot: Applicant: Health Dept. Approval: Plaaning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Underwriters Approval: Final Certificate: (check one) -- ~A~~lla~ Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY I 1971-0959 Telephone (631 ) 765-1802 Fax (631) 765-9502 ro.qor, richertCb, town.southold.n¥.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Kevin Polac Address: 57995 Route 25, Main Rd City: Southold St: NY Zip: 11971 Building Permit #: 36877 Section: 55 Block: 6 Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Elec mec IRC LicenseNo: 4814-me SITE DETAILS office Use Only Residential l~ Ind°°r l~ Basement I~ Service Only~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 3 ph Hot Water GFCI Recpt Main Panel A/C Condenser Single Recpt Sub Panel A/C Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: 200a overhead service to existing building Ceiling Fixtures I~ HID Fixtures Wall Fixtures ~l Smoke Detectors Recessed Fixtures ~ CO Detectors Fluorescent Fixture ~ Pumps Emergency Fixture~ Time Clocks Exit Fixtures ~ TVSS Notes: Inspector Signature: <~ ~ Date: Jan 27 2012 81-Cert Electrical Compliance Form.xls TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~_F. LECTRICAL (FINAL) REMARKS: DATE iNSPECTOR<~~~:~-- TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ]FRAMING/STRAPPING [/J~INAL [ ]FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROU~RICAL (FINAL) REMARKS: DATE ~INSPECTOR~ ~~/ TOWN OF SOUTIfOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork. net Exanlined Approved Disapproved a/c Expiration DEC -8 2011 BLDG. DEP/. TOWN OF SOUTHOLO PERMIT NO. .3f~p ~7 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees C,O. Application Flood Permit Single & Separate Storm-Water Assessment Form Contact: Mail to: ~Etq,4 Building Inspector ACATION FOR BUILDING PERMIT Date INSTRUCTIONS /.2- g'-// ,20 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 adjoiniug 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. Snch 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 pa~ lbr any purpose what so ever until the Building Inspector issnes a Ceaificate of Occupancy. f. Every building permit shall ~xpire if the ;;ork authorized has not commenced within 12 months aaer the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the prope~W have been enacted in die 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 Depamnent for the issuance ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Soffolk 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. OCC,J, ANC r OR o,'a~,t or na~e, iCar~ion) ...... ~' ~ L;TIFY BU~_, ~; m 'A:TL~ENT AT, Stme whether applicant ~s owner, tS¢~e, ~OLLOWlNGt, '% ~ hNS: ~-~ 1 FOUNDATI)~ /,... REQUIBED 2.~OUGH (As on the tax rotl or latest dee~ NSU~TION--b Name of owner of premises If applicant is a corporation, signature of duly' authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed work will be done: House Number Street kwt'('0[' ( 3MF,.~. i'E FOR CO. /,Lt. GONSTRUCTION SHALL MEET THE RI~(31JIREMENTS OF TUt: CODES OF NEW Yfll~, STATE, NOT RESPONSIBLE FOR ,¢M~--~ {~N OR CONSTRUCTION ERRORS. Hamlet CountyTax MapNo. 1000 Section/qr]~"~,-~"5't"Block ~ Lot ,>Dr./ Subdivision Filed Map No. Lot · 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~S-~,,q[5 b. Intended use and occupancy__ Nature of work (check which applicable): New Building Repair Removal Demolition Estimated Cost 1~ ~. OO 3. Additiou Alteration Other Work (Description) 4. Fee (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 of each type of use. 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear Dimensions of same structure with alterations or additions: Front ~/~ t Depth / ~'. q ° Height ~';0 ' Number of Stories Depth Rear / 8. Dimensions of entire new constructiou: Front Rear .Depth Height Number of Stories 9. Size oflot: Front 1~ ' Rear /t¢O-~'O ! Depth 10. Date of Purchase r]/I,.~/lt Name of Former Owner 11. Zone or use district in which premises are situated ~ ~l Iq'[ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES __NO 13. Will lot be re-graded? YES NO_ ,?,~Will excess fill be removed from premises'? YES NO ~ 14. Names of Owner of premises~EV~-*~.a/~J~/~.~ Address '~5""P'"/W,~,~/, ~///tJ Phone No. ~3"'~ ~ ~O,~ /'~,-~"- Name of Architect Address Phone No Name of Contractor (2r4?_jgF, ~°t~ (.A-~ Address/3''el/-O~ _/~'" Phone No. _~ ?} ~ ,)'8'/~ ~ 2~ g~ 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. 18. Are there any covenants and restrictions with respect to this property? * YES NO ~'/ · IF YES, PROVIDE A COPY. STATE OFNEW YORK) OUNT S: ~0,, ~'q~. P 0J[ 6'- k being duly sworn, deposes and says that (s)be is the applicant (Name of individual signing contract) above named, (S)He is the (', Llo'"-4x.~"~ 4, l ',~Jt¢ ~-(~-.~' - (Cont~ctor, ~gent, 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 file~~UOl~¥0~ Swo~ before me thig~ t~ ,- r ~ ~ day or ~tkl.lC.k.J~ 20 ~ Notary Public Ou~f~ k~ $uflok Commi~ Expires A~il ?' Signature of Applicant Towa Hall Annex 54375 Main Road P.O. Bo~ 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Bun.rHNG DEPARTMENT TOWN OF $OUTitOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: License No.: Address: Date: JOBSITE INFORMATION: ( Indicates required information) *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax Map District: 1000 Section: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) Lot: (Please circle All That Apply) *Is-job ready for inspection: .*Do you need a Temp Certificate: *Service SmZe: ' /~has~) 3Phase *New Service: Re-connect Additional InfOrmation: 82-Request for Inspection Form Rough In Final 100 Underground PAYMENT DUE WITH APPLICATION 150 ~ 300: 350 400 Other Number of MeteJ~) Change of Service LONE iSLAND RAIL ROAD (UTA)