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Home My WebLink About28017-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28563 Date: 07/01/02 THIS CERTIFIES that the building ALTERATION & ADDITION Location of Property: 54075 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 61 SOUTHOLD (STREET) (HAMLET) Block 2 Lot 7.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 8, 2002 pursuant to which Building Permit No. 28017-Z dated JANUARY 17, 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 ALTERATIONS & HANDICAP RAMP REPLACEMENT TO EXISTING PROFESSIONAL OFFICE BUILDING AS APPLIED FOR. The certificate is issued to SOUTHOLD PROFESSIONAL OFFICES,LLC (OWNER) of the aforesaid building. SUFFOLK COUIT/~DEPARTMENTOFHEALTHAPPROVAL ELEt-£RICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'r~a3 06/17/02 N/A 60274 03/20/02 CUTCHOGUE EAST PLUMB&HEAT uth ~ iz~S%~nature 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. 28017 Z Date JA/qUARY 17, 2002 Permission is hereby granted to: SOUTHOLD PROFESSIONAL OFFICES, 54075 MAIN ST. SOUTHOLD,NY 11971 for : ALTERATIONS AND HANDICAP RAMP REPLACEMENT TO AN EXISTING PROFESSIONAL BUILDING at premises located at 54075 County Tax Map No. 473889 Section 061 pursuant to application dated JANUARY Building Inspector. MAIN RD SOUTHOLD Block 0002 Lot No. 007.003 8, 2002 and approved bythe Fee $ 200.00 Authori~'d Signature COPY Rev. 2/19/98 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF O~17I This application must be filled in by typewriter or ink and submitted to the Building Department with the following: Ao 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 fi~om 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 certifical of Code Compliance from architect or engineer responsible for the building. Submit Planning Board Approval of completed site plan requirements. 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. If a Certificate of Occupanc) is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. 1....Certificate of Occupancy- NeW dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool'S25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Photocopy of Certificate of0ccupancy - $ 0.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.0~0 Date. New Construction: Old or .Pre-existing Bttil,~.. · (check one) qw07 f- fid. ,/ ...... ~,, ~ . (/.% Suffolk County Tax Map No l000, Section ~7~ oc~>~ Block ~/,-~ -'7, :~ Lot Subdivision Filed Map. Lot: Permit No.~! 7 --~,~ Date of Permit. Health Dept. Approval: . Applicant: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: b'/ (check one) Feb Submitted' $ /~~. ~ ~ ~ ~ --- Applicant Slgnatur~,,~e Town Hall, 53095 Main Road P,O. Box1179 Sou~hold, New York 1197~ Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E RTI F I CA? I O N Building Permit No. (please print) (please print) I certify that the solder used in the water supply system Sworn to before me this ..~.._ day of Notary Publt. c, contains less than 2/10 of 1% lead, ...L 1'~ RICHARD NONCARROW ~ Nota~ Public, ~ of New Y~, County No. ~1~ mrm ~r~ ~ 81, ~ Elec t'ical Zn$pec Hon Cet'H 'ca Date Electrical Inspection Service, Inc. ~ 3/20/02 375 Dunton Avenue 60274 East Patchogue, NewYork 11772 (631) 286-6642 Issued to: Street: Village: Section: Southold Professional Offices 54075 Main Rd Southold Zip: 11971 Block: Lot: Town: Southold Introduced by: Lademann Electric Inc. Lic.# 4141-E w~.~ e.x~mined ~nd fo~d ~o ~ t~ com~b~ wffh ~h~ ~1 ~lzc~ic=l C~e ~ Comme~lal ~NVDefects ~'~. Pool ~lstFIoor ~lndoor ~Basement ~ Hot Tub ~ Residential ~ Dat. Garage ~ ~Afflc ~ ~2nd Floor t ~Outdoor ~ Addition ~Su~ey Switches Receptacles Fixtures GFI Heaters A/C Fans 7 23 10 5 1 Dishwasher Washer/Amp Dryer/Amp Oven Range/Amp Garbage Disposal Furnace 011 Meter Amps= phaSe UG/OH Gas Circulator Telephone Smoke Detector Bell Transformer Television Carbon Monoxide Building Permit # Hugo $. $urdi President Other Equipment: Rough Inspection: 2/12/02 inspector: Quentin Reynolds Final Inspection: 3/19/02 ]inspector: Quentin Reynolds This certificate must not be altered In any manner. Inspectors may be iden~fled by their credentials ANTHONY BENNABDO, M.D., P.C. Internal Medicine 1675 JOCKEY CREEK DRIVE SOUTHOLD, NY 11971 Telephone (516) 765-2995 Mr. Michael Verity Southold Town Building Dept. Main Road Southold, NY 11971 January 15, 2002 Dear Mr. Verity: Please be advised that the 2nd level of Southold Professional Offices will not be used as part of the physician's office. It has been and will continue to be occupied by Geraldine Kazenoff and Richard Farrell who are practicing Psychologists. Thank you. AB/sp PLANNING BOARD MEMBERS BENNETT ORLOWSKI, JR. Chairman WILLIAM J. CREMERS KENNETH L. EDWARDS GEORGE RITCHIE LATHAM, JR. RICHARD CAGGIANO P.O. Box 1179 Town Hall, 53095 State Route 25 Southold, New York 11971-0959 Telephone (631) 765-1938 Fax (631) 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: From: Re: Michael Verity, Principal Building Inspector Bennett Orlowski, Jr.,Chairma~ Proposed Medical Offices Main Rd. (RT 25), and Beckwith Ave. SCTM: 1000-061-2-7.3 Date: January 9,2001 At your request, the Planning Board staff has reviewed the history of this parcel, which had received Site Plan approval for a two lot subdivision on October 8th, 1984. The current proposal to replace a law office with a medical office does not change the uses or the intensity on the site, and therefore will not require a new site plan .The renovations to the structure and the entrance ramp do not affect the footprint of the building and are acceptable. The Planning Board asks that an AS-Built plan be provided to this office upon completion of the renovation. ; / f - Z - TOWN OF SOUTHOLD PROPERTY RECORD CARD ~WNER STRE~ Yg'~ 7~ V,'~GE D,ST. ~U~. ~O~ FORMER OWNER~, Oamini+C ~d/f N ' - E . . . ACR. ~*td ~ ~~, S W ' ES. ~: S~S. VL. FA~ COMM. CB. MISC. Mkt. Value ~ND IMP. TOTAL DATE ~o00 ~9og ~9oo 9-1-t~ ~ AGE BUILDING CONDITION [ ] I q ~ NO~L BELOW ABOVE =ARM Acre Value Per Value Acre illable illable 2 liable 3 ~oodland vampland FRONTAGE ON WATER 'ushland FRONTAGE ON ROAD Plot Duse DEPTH ~ ~ BULKH~D )roi DOCK ~OLOR tRIM M. Bldg. Extension -~xtension Extension :)orch )orch Breezeway '~a rag~k~ Patio j Total I ,20 Foundation Basement Walls Fire Place Type Roof Recreation Roorr Dormer Driveway Bath Floors Interior Finish Heat EL ~ c ' Rooms 1st Floor '7 Rooms 2nd Floor ,~ Dinette K. LR. DR. BR. FIN. B. PLANNING BOARD MEMBERS BENNETT ORLOWSKI, JR. Chairman WILLIAM J. CREMERS KENNETH L. EDWARDS GEORGE RITCHIE LATHAM, JR. RICHARD CAGGIANO P.O. Box 1179 Town Hall, 53095 State Route 25 Southold, New York 11971-0959 Telephone (631) 765-1938 Fax (631) 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: From: Re: Michael Verity, Principal Building Inspector Bennett Orlowski, Jr.,Chairma~ Proposed Medical Offices Main Rd. (RT 25), and Beckwith Ave. SCTM: 1000-061-2-7.3 Date: January 9,2001 At your request, the Planning Board staff has reviewed the history of this parcel, which had received Site Plan approval for a two lot subdivision on October 8fa, 1984. The current proposal to replace a law office with a medical office does not change the uses or the intensity on the site, and therefore will not require a new site plan .The renovations to the structure and the entrance ramp do not affect the footprint of the building and are acceptable. The Planning Board asks that an AS-Built plan be provided to this office upon completion of the renovation. BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: .] / c]/01~, :~o .DATE SUBMITTED: / /c'5' /0~ SCTM# DISTRICT: 1,000 SECTION:. 6-// BLOCK: ~ LOT: -~.-~ STREET-~-qcv -9~- F,O~,~, ~.-~-. CITY: ,~, ~ r,, ~ ~.~ SUBDW. NAME: '~/'~ PROJECT DESCRIPTION: ~t rc~v ~a 75~ ox, s /~,~ ~ ~ ,g~,> ~ , ~ / ~C~ECT / ENG~ER: /o r~,, ~ FAST T~CK? S~GLE & SEP~TE CERT~ICATION-~Q~D? ~ NOTES: ~ ~,~SF -1~-24~ ~t ~iOm.(C~D ~f~ June 30, 1983), ~DE~ED ~ ~OM J~.199~ 1~-25. M~.(A nonconfo~ng at any fim~ a~r 7/1~ ZO~G D~T~CT: ~ CO~O~G? ~ o ~Q. ~T $~: ~/v va ACT. LOT S~:~ ~Q. LOT COV. ACT. LOT COV. RBQ. FRONT 15~ REQ. REAR 2 ~'~ WATER FRONT? PROP. FRONT cP '~ ACT. SIDE PROP. REAR ' ~ '~ ~ ~ ,~'~ c ~ "~'~cpe FLOOD ZONE: 3 AGENCY PERMITS REQUIRED FOR REVIEW APP~S REQUIRED: SUFFOLK COUNTY HEALTH DEPT: YES of'~ED #): DTE:__ __ NEW YORK STATE DEC: ~R~-n~C ~ar/s YES or(~ SOUTHOLD TOWN TRUSTEES: YES TOWN ZONING BOARD APPROVAl,: YES or~-x) TOWNPLAN. BOARD APPROVAL: YESo~"-"~ o,.Lcz TOWNHISTOKICAL pRE (SPLIA): YES or O~QJ NYS ENERGY: YES O NR~O :) EGRESS (18 H min.? 4 sq't6~l) ' VENT (SQ. F~T. x 4%) BUILDING PERMITS OPEN/EJ~IRED: BP I q I ~;fr55 -Z / C/0 Z- HAVE PRE CO'S: Y ORN BP -Z / C/0 Z- NOTES': / / PERMIT ~:R10- LIGHT (SQ. Fr. x 8%) STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLR: SF TOTAL: ~q SF INIT OTHER TOTAL FEE FEE FEE 'OT( SF)- ( SF)= SF X $ =$ +$ +$ = $ Owners Nmne: Reviewed: ~.- Architecl/ ~~.~ Engineer: 7~~ Date Submitted: SCTM fl: f)~strict: 1,000 Sec~o.: .~./' mock: ~T ~.ot: ~ Projecl Subdivision I .ocalion: Name: Single & separate Required certification: (Yes / No) Req Rcq. Zolfing I)islricl:__ Jl,ol size: Aclual: J JLol coverage Ploposed Req Req Req [From Yard __ Proposed:__] {Side Yard Proposed: ] [Rear Yard __ Proposed Project Description: AGENC~ERMITS REQUIRED FOR REVIEW Suffolk County Health Dept. New York State D.E.C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: Permit N.A. NO YES _Number 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [~'I~UGH PLBG. [ ] FOUNDATION 2ND [ [ '~'FF~MING [ ] INSULATION ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY REMARKS: [ ] ROUGH PLBG. [ ] INSULATION [ ~I~AL DATE 0~~~-- INSPECTOR _~~ ~ FIELD INSPECTION REPORT I DATE I COMMENTS FOUNDATION (1ST) FOUNDATION (2ND) INSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS · TOWN OF SOUTItOLD BUILDING, DEPARTM-ENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 ~Ppr°w//~' f7 Disapprov~ c P~mm'r ~o...2~ o/7~ ,20 O 2.- ,20 BUILDING PERlvlIT APPLICATION CI-IECKLIs Do you have or l~od tho followhag, before applyi~ Board of HeaRh --~ ~(3 sets ofBuiltting plan~ F X Survey. · ' ,K Cheek Septic Form N.Y.S.D.E.C. Tmstees Conlact: Phone: Building Insl~ctor [ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS /' - 7 ,20az:_ a. This application MUST be completely filled in by typewriter or ix ink and submitted to the Building Inspector ~rith 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 waterways. c. The work covered' by this application may not be commenced before issuance of Building Permit. d. Upon approval ofth/s application, the Building Inspector.will issue a Building Permit to the applicant. Sucli 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 a Certificate of Occupam is issued by the Building Inspector. APPLICATION IS HF_,REBY MADE to thc Building Department for the issuance of a Building Permit pursvant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the consu-u~on of buildings, additions, or alterations or for removal or demolition as herein described. The applic .ant a.grees re comply wi~ ~ app. licabic laws, ordinances, building code, housing code, and regtdafio.ns, and to ad.m/t authonzedmspectorsonprennsesandmbuildingfornecessa~yinsp¢ctions~ .~ /~,. -°7 ..... (Mailint address of applicant) f~-' /lq') / State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder yName of owner of premises (as on the tax roll or latest deed) If apphcant as 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. 1. Location of land on which proposed work will be done: 5~o75- mo-/r~r .f7--- House Number Street County Tax Map No. 1000 Section Subdivision (Name Hamlet ' --7.3 Block Lot Filed Map No. Lot State existing use md.occupancy ofpre~nises and intended use and occupancy ofPr°P°sed con~ixuction: a. Existing use and occupancY ~~/0/:::---~/ ~ O/c~C,~ b. Intended use and occupancy /~7 ~D/£/~-- d~ ~-~c~/~ e. ~ ~t~/a c7~/~ Nature of work (check which applicable): New Building. Repair Removal Demolition Addition Alteration Other Work Estimated Cost bO,: ~[) -- Fee (DeScription) (to be paid on filing this application) Number of dwelling units on each floor A)~- If dwelling, number of dwelling urdts If garage, number of cam If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing ~ttuctu~es, if any: Front Height. Number of Stories Rear Depth Dimensions of same struCture with alterations or additions: Front · Depth Height Number of Stodes 8. Dimensions of entire new c0n~huction: Front Rear Depth Height Number of Stories 9.. Size of lot: Front Rear 10. Date of Purchase Name of Former Owner 11. Zone or use dish-let in which premises are situated ./f~t~/.~rT- b F 3-~t77~/.-D 12. Does proposed construction violate any zoning law, ordinance or ~egulation: ~ 13. Will lot be re,graded Will excess fill be removed from premises: YES NO Address Phone No. Address Phone No Name of Contractor J>//-~ ~=~-fB£ Address~ /"~9/J. °/7 ~ Phone No, '&~/ ?Z.z- 5 6 ~ 15. Is ~s ~op~ ~thin' 100 f~ of a fi~ wefl~d? *~S NO ~ * W ~S, SO--OLD TO~ TRUSSES PE~S ~Y BE ~Q~D 16. Provide survey, to scale, with aCCUrate foundation plan and distances to property lines. 17. If elevation at any poinf on property is at 10 feet or below, must provide topographical data on survey, ~TATE OF NEW yORK) (Name ofi~dividual si~i-g contract) above framed, [~)He is the 0 ['JA],O/(~. . being duly sworn, deposes and says that (s)he is the applicant (Coat-actor, 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 application; J~at all statements contained in thi.q applieatkm are tree to the best of his knowledge and belief; and that the work will be )efformed in the manner set forth in the application filed therewith. ~wom to before me ~ ~ - / / /~ '774 200 ary Public GEORGE P JAN~OW-qKI Notory Pubr.: - State of New ¥cmk NO. 01JA7072~0 . Ouorrrmecl in Suffo{k C_ounty .... i I I /