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Home My WebLink About28447-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28559 Date: 07/01/02 THIS CERTIFIES that the building REPAIR Location of Property: 43385 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 75 Subdivision Filed Map No. (STREET) Block 1 PECONIC (HAMLET) Lot 16 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 10, 2002 pursuant to which Building Permit No. 28447-Z dated JUNE 10, 2002 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 PORCH REPAIR TO EXISTING RETAIL STORE AS APPLIED FOR. T~e certificate is issued to BALTIC PLACE INC. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF MRALTH APPROVAL ELEt-I'RICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA-rED N/A N/A //th/zed Signature Rev. 1/81 Form 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: 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. o£water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board o£ 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. Submit Planning Board Approval of completed site plan requirements. Ao Be 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 a consent to inspect signed by the applicant. Ifa 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- $25.00 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: Location of Property: 4ff~ ~ ~ House No. / Street Owner or Owners oferoperty: 4~L~c:/;~ ~ ~.p~~,../~'7~'~~~ / fi' ' "I - " Suffolk County Tax Map No 1000, Section ~ ~pt0~lock .~_ _DO~?' Lot ~/~ Subdivision )~f / ~ ~ Filed Map. -- Lot: --~ PermitNo.~ateofPennit..,¢"~G,~ ./?~./_ Applicant:~._~t~ ~4.~ jAx~/ Health Dept. Approval: Underwriters Approval: (check one) Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ c~ ~ ~ Final Certificate: (check one) ~ Applicant Signature TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST SUB. 6/I YN ')U " ,,' .' FORMER O N N E ., ACR. ~~kk, no~ --T- ; - . r'.. ;,,,,,,, ...~ ~_ /,~ ~ .. ~ . ~ . . ~--~ W . , '~ r'~ (fl' l~, , / TYPE OF BUILDING LAND IMP. TOTAL DATE REMARKS AGE BUILDING CONDITION , - · ' - NEW __ NORMAL BELOW ABOVE O0 ~S~ .... FARM Acre Value Per Value Acre 'illable 1 'illable 2 illable 3 /oodland wamptand FRONTAGE ON WATER rushland FRONTAGE ON ROAD 'ouse Plot DEPTH ~" BULKH~D :tal DOCK :tension ,rch reezeway ~rage oral COLOR TRIM Foundation Basement Ext. Walls Fire Place ~e Roof ~,ecreation Room ~ ' ' /' Interior Finish "~ ~[ Heat Rooms 1st Floor Rooms 2nd Floor Dormer Driveway 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ]FRAMING [~L'- DATE INSPECTOR Al)l} I T I ()NAI, COHHEN'I'5: ' ill o r, FORM NO. 1 i~;:~I ]~IIC u I?!(; TOWN OF SOUTHOLD ~__~_ .............. BUILDING DEPARTMENT: ri_!.xZ :': ~ I TOWN ttALL TOW!,! Or S~?~'~;~O~? SOUTHOLD, N.Y. 11971 TEL: 765-1802 Examined .~.~.-, Disapproved a/e ................................ :.. ........ ' AP~OATION FO~ BUILDING PERMIT BOARD 3 SETS Ot~PLAi','S ....... SURVEY . ........... t;oT I Fy } CALL ......... INSTRUCTIONS 'a. ]'Iris application must be completely filled in by typewriter oriu iuk and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. .b. Plot plan showing location o£ lot and of buildbrgs ou premises, relationship to adjoining premises or public or areas, and giving a detailed description of layout o£ property mu~t be drawu ou the diagram which is part of this app cation. c. The work covered by this application may not be commenced before issuauce of Building Permit. . d. Upou approval of this application, the Building Inspector will igsued a Building Permit to the applicant. Such pent shall be kept on the premises available for inspection throughout tire work. e. No buikling shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupam shall have been granted by tire Building Inspector. APPLICATION IS HEP, EBY MADE to the Buildbrg Department for the issuance of a Building Permit pursuant to ti Buildiug Zone Ordiuance of the Town of Soutb01d, Suffolk County, Nexv York, mrd other applicable Laws, Ordinances Regulations, for tire construction of buildings, additions or alterations, or for removal or demolition, as herein descrlbe~ The applicant agrees to comply with all applicable laws, ordinances, buildiug code, housing code, and regulatious, and admit authorized inspectors on premises aud iu building for necessary inspections. (Signature of applicant, or name, if a corporatio,) ..... .o. . . . . / '.z. . ., .d,o. f. .o:lo. ' (Mailiug address of applicant) /]~ State whether applicaut Js~lessee, agent, architect, engiueer, general contractor, electrician, phunber or builder Name °f °xvner °f premises ~~~ (as on fl~e tax roll or latest deed) If applicant is a corporation, siguature of duly authoriied officer. (Name and title of corporate officer) Builder's License No. Plumber's License No. Electriciau's License No. Other Trade's License No. 1. Locatiouoflandon which proposed work will be done. .'.t.... .....i. llouse Number Street llamlet Cot','ty Tax MapNo. lO00Section ' -O..Z~-,'~ ....... Block .0./. ' Lot.../.(~ ............ Subdivision -- ........ · ............................ '. Filed Map No. -- (Name) .............. Lot ..... .~. ........ 2: Slate existiug use and occupaucy of premises and inteuded use aud occupancy of proposed construction: b. Intended use and occ,,pn,,cy ~-~k(5~..I ___~.0..Idjn~ 3. Nature of work (check which applicable): New Building .......... Addition Alteration Repair , .~. .......... Removal .............. Demolition 4. Estimated Cost , (Description) ....... " ............... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units .... /-.. ........ Nnmber of dwelling t, itsoneach floor · If garage, number of cars .............. . ....................... ? ................... 6. If business, commercial or ,nixed occupancy, specify nature and extent of.e' c 7~ . Dimensions of same structure with alterations or additions: Front ...%~r'l~. ........ Rear. :55~rlq~. 5[]5 ..... 8. Di,nensions of entire new construction: Front ' ...... -'w ....... : Rear .-~. Depth ...: ........... lleight ..... -:-. ........ Number of Stories -- . ...... 11. Z . . .' .-..., ...... . ................ Name of Fom~erOwner '.ad_. ....... :" ,,one or use district m which prelmses are situated ./~- r'"~ / .... ~t~.~...,:.. ~.~. 12. t Joes proposed constrnction violate an,, z^--;-,~ ,~--.' ' '-. ' ~ ......... . ......... ................... ~ · .'.. 3. ~s-nl; ~aw, ordinance or regulation: .F)eo ......... . 13. Will 10t be regraded ...... /././~,o ................... Will excess fill be remOve · . 14. Name of Owner of premises l~:>r./Vd~/gc~' D ~1~, h-,~ . ,~ tV.. ~ ,~ d from premises. Yes Name of Contractor ............. ,... ~tadress v~-ff~3.~ /"/41lO, ., ., .~] ..... Phone No. Zd.'3.4. -~'4~.' " .......................... Address ......... Phone 15. Is t:bls property w:i_tl~in 300 feet of a tidal wetland? x '~.' ..... . No ' · If yes, Southold Town Trustees Per~ ..... , ' Y~s.; ...... lq,.,.,3~. ' · ,.~,- mcty De required. ' ..... PLOT DIAG RAM 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. TATE OF NEW YORK, O U~f'y OF .......... S.S .... ........ ......... (Name o.f individual signing contract) )ore named. being duly sworn, deposes and says that he is the applicant is the . . (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this plicalion; that all statements contained in this application are t'rue to the best of his knowledge and belief; and that the )rk will be performed in the manner set forth in the application filed therewith. ~om to before me this ~ ~ M~ ~, 1~ (Signature of applican t)