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HomeMy WebLinkAbout40221-Z ��Qti4 tpGl Town of Southold 9/18/2018 P.O.Box 1179 a o 53095 Main Rd o�Brp� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39907 Date: 9/18/2018 THIS CERTIFIES that the building ALTERATION Location of Property: West St,Fishers Island SCTM#: 473889 Sec/Block/Lot: 9.4-8.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/27/2015 pursuant to which Building Permit No. 40221 dated 10/27/2015 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: EXISTING BUILDING CONVERTED TO A ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Shillo,Deborah of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-17-0038 03-19-2018 ELECTRICAL CERTIFICATE NO. 40221 08-30-2018 PLUMBERS CERTIFICATION DATED 04-27-2016 Glen Gallo VW o ' e Signature TOWN OF SOUTHOLD BUILDING DEPARTMENT y TOWN CLERK'S OFFICE o . 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 #: 40221 Date: 10/27/2015 Permission is hereby granted to: Shillo, Deborah 26 Highwood Rd Bloomfield, CT 06002 To: ALLTERATION OF AN EXISTING RETAIL STORE TO A 3 BEDROOM SINGLE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP#32184 At premises located at: West St, Fishers Island SCTM # 473889 Sec/Block/Lot# 9.-4-8.2 Pursuant to application dated 1/1/1900 and approved by the Building Inspector. To expire on 4/27/2017. Fees: PERMIT RENEWAL $397.60 Total: $397.60 din 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. 32184 Z Date JULY 5, 2006 Permission is hereby granted to: DEBORAH S SHILLO 26 HIGHWOOD RD BLOOMFIELD, CT 06002 for ALLTERATION OF AN EXISTING RETAIL STORE TO A 3 BEDROOM SINGLE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES 27075 . at premises located at WEST ST FISHERS ISLAND County Tax Map No. 473889 Section 009 Block 0004 Lot No. 008 . 002 pursuant to application dated JULY 5, 2006 and approved by the Building Inspector to expire on JANUARY Fee $ 397 . 60 i S ' nature ORIGINAL Rev. 5/8/02 l 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. 27075 Z Date FEBRUARY 16, 2001 Permission is hereby granted to : DEBORAH S . SHILLO 26 HIGHWOOD RD. BLOOMFIELD„ CT 06002 for ALTERATION OF AN EXISTING RETAIL STORE TO A 3 BEDROOM SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at WEST ST FISHERS ISLAND County Tax Map No. 473889 Section 009 Block 0004 Lot No. 008 . 002 pursuant to application dated OCTOBER 23 , 2000 and approved by the Building Inspector. Fee $ 397 . 60 Auth L4 -ed Signature ORIGINAL Rev. 2/19/98 SEP 1 2 2018 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT BUILDING DEPT. TOWN HALL TOWN OF SOU'T)IiOLD 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: 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 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 Planning Board Approval of completed site plan requirements. B. 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 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,Commercial$15.00 Date. 7-12-2018 New Construction: Old or Pre-existing Building: X (check one) Location of Property: 102 WEST STREET FISHERS ISLAND House No. Street Hamlet Owner or Owners of Property: DEBORAH S. SHILLO Suffolk County Tax Map No 1000, Section 9 Block 4 Lot 8.2 Subdivision Filed Map. Lot: Permit No. 40221 Date of Permit. 2-1-2001 Applicant: DEBORAH S. SHILLO Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: X (check one) Fee Submitted: $ 50.00 Applicant Signature pF 50!/T,�ol Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G Southold,NY 11971-0959 �0 • �o roger.richertt D-town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To- Deborah Shdlo Address: 102 West St City: Fishers Island St: New York Zip. 6390 Building Permit# 40221 Section: 9 Block. 4 Lot: 82 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Z&S Contracting License No. 4798-ME SITE DETAILS Office Use Only Residential X Indoor X Basement X Service Only Commerical Outdoor X 1st Floor X Pool New Renovation X 2nd Floor X Hot Tub Addition Survey X Attic X Garage INVENTORY Service 1 ph 200a Heat oil Duplec Recpt 51 Ceding Fixtures 30 HID Fixtures Service 3 ph Hot Water oil GFCI Recpt 9 Wall Fixtures 18 Smoke Detectors Main Panel 200a A/C Condenser Single Recpt Recessed Fixtures 14 CO Detectors Sub Panel A/C Blower Range Recpt 20a Fluorescent Fixture 3 Pumps Transformer Appliances dw Dryer Recpt30a Emergency Fixtures Time Clocks Disconnect 200a Switches 43 Twist Lock Exit Fixtures TVSS Other Equipment: "AS BUILT" "ELECTRICAL SURVEY" "NO VISUAL DEFECTS" Notes. 4-paddle fans Inspector Signature: Date: August 30 2018 81-Cert Electrical Compliance Form As TEL.765-1802 ' TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR v �z P.O.BOX 728 �•r' TOWN HALL y SOUTHOLD,N.Y'. 11971 SEP -BMD04G DEPT: TOWN OF SOUTH®LD C E R T I F I C- A%T_ I Q N , DateY./--c; Building Permit No. Owner Dc&J-4. (please print) . Plumber— (please Plumber (please print) - '- I certify that the solder used in the water supply system contains less thaw °2/10• of 1% .lead. . (plumber's signature) Sworn to before m� this , • day ofpi, Lary .Public ' N tart' •Public, Ci��r� ✓� ` _ - n ifs& e 0 cou TOWN OF SOOT DING .DEPT. 765-1802 IN ION [ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING / STRAPPING [ INAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) CODE VIOLATION [ ] CAULKING REM KS: DATE �� INSPECTOR La vY OF SOUly�lo TOWN OF-SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] SULATION FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) � t ik _ • �1k Vy6) REMARKS _ � J - � 3 i DATE l INSPECTOR ,- EVELYN COLEIT HIT T , LLC PO Box 182 August 15, 2018 134 Main St Putnam, CT Mr. Michael Verity, Chief Building Inspector 06260 Town of Southold 8603159570 Town Hall Annex Building 5375 Route 25 PO Box 1179 Southold, NY 11971 Re:Application for Certificate of Occupancy Permit No. 40221 Dear Mr.Verity, As a duly registered architect in the State of New York, I have reviewed the Building Permit application number 40221,dated February 1, 2001, and associated submittals on file in the Building Department records in Southold,for modifications to a commercial property for use as a single- family residence, located at 102 West Street, Fishers Island, NY. As the Building Permit was not closed out with a formal Certificate of Occupancy at the time of completion of construction, I submit this letter to accompany the Owner's Application for a Certificate of Occupancy. I have visited the site and reviewed the New York State Uniform Fire Prevention and Building Code- 1984 which was in effect at the time of the application and construction. Based on an inspection of visible building elements and code review, I hereby state that the modifications were constructed in substantial conformance with the applicable building code. Please call upon me if you require additional information. Sincerely, ED ul -4 Evelyn Cole Smith, AIA, LEED-AP �� 1 � OF IN D SEP 1 2 2018 www,ecsorchifecfs.coni BUILDING DEPT. TOWN OF SOUTHOLD FIELD-INSPECTION=REPORT COMMENTS - =DATE _=s__-__�__________ __===== =====______+_____ II II t�! I , HI FOUNDATION ( 1ST) --�fl FOUNDATION (2ND) --- --------- ------------------ ii ° - °I� 'i x n o ROUGH FRAME & PLUMBING it ij n cn u I INSULATION PER N. Y. STATE ENERGY CODE u n u oll Coo kt..X CW ro UD ° 3 ` .;s• FINAL II ISS .(/�(ijlq Ml0't I /v S • d I ----------------ADDITIONAL COMMENTS_-- ---------------------------- ----------__—_________—_______ 167 1' G [16 U/Ut --l1� �o � R HI � r � ro y In BOARD OF HEALTH . .. . ... . . . .. . . . FORM NO. 1 3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY .... . . . . . . .. .. . . . . . . . . . . BUILDING DEPARTMENT CHECK .. . . . . . . , TOWN HALL SEPTIC FORM . . . . . . . . . . .... . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: CALL . . . . . . . . . . . . . . . . . . Examined..../,/1Z-; ......... . -3l MAIL TO: . . . . . . . . . . . . . . ... . . . Approved... //.�.........XW.. Permit No. .................................> Disapproveda/c .................................. .................................. .....................................................&tor .(Building . APPLICATION FOR BUILDING PERMIT Z 000 Date. Qc4o 9 P2--, I g' i-9-. . . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector w 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 nest be drawn on the diagram which is part of this application. 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 permit shall be,kept on the premises available for inspection thromg'mout 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 BAY 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 cmVly with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ..... :w. : ............................. (Signature of applicant, or nape, if a corporation) • a?to �-1 i�tJ (.�o o D '1zy7 ........... L r�.�..�..r..... 0( .o°......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,.general contractor, electrician, plumber or builde ........................................................NlZrv2�a1,L b..............................................:.... ..... Name of owner of premises ....�Q g .�:......5:...... I-I.,.L-.L. V........................................................ as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. Plumbers License No. ......................... w N O u9• l( �2P�aP /n�B2 Elecfricians-License'llb. ` Other Trade's License No.._..23 Fs..... 2... 1. Location of land on which proposed work will be done..... ....../©..i� .................................................. .............. .................................`s " > I ........ .. .. . ...,Y, ........................................... House Number Street Hamlet —County Tax Map No. 1000 Section ..........,....:..,Block ................ Lot ...... Subdivision ....... .............................. Filed Map No. Lot;•,:; ..;s. ....., ,.a (Name 2. State existing use and occupancy of emises and intended use and occupancy of proposed'constnmctioci:''`` ' S . L a. Existing use and occupancy ..... . ......... ................................,.......................,.... b. Intended use and occupancy ....��:.e'er " .......................................................... —f i•.ILULC UL wv►K %.uW�LK wiuul APP11wI LCJ; ►vex DUI.LU11.18 ........... ......... 1wuiLluu�...... ., euLera[iOn Repair ....x..... Removal Demolition ............ Other Woi'k r/ �,. (Description)1Si f Z s'j�F/fie S i. Estimated Cost .....0:17.f............. fee ...... .......��...'to......................... t I '(to be paid on filing this application) 3. If dwelling, number of dwelling units ............ Number of dwelling units on each floor ................ Ifgarage, cumber of cars ...................................... i. If business, commercial or mixed occupancy, specify nature and extent of each type of use...................... 7. Dimensions of existing structures, if any: Front................ Rear ............... Depth ................. height ........................... Number of Stories ...................... _ Dimensions of same structure with alterations or additions: Front ............... Rear ............... Depth .................... Height .................... Number of Stories ............... 3. Dimensions of entire new construction. Front ................ Rear ............... Depth . Height ......................... Naber of Stories ..................... 3. Size of lot: Front .................... Rear .................... Depth .................... 10. Date of Purchase �l�.r.�v........ Name of Former Oc ner ..... V' I.. .....�¢4� II. Zone or use district in which premises are situated .. ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................ 13. Will lot be regraded .. N ... Will excess fill be removed from emu YES Na �J wp �e . On 1 n G o�� �e� CT �caodz NoN 91 aya-�s�W 14. Names of Owner of premises ... °Q"�..S::S U.. ....... Address `3�°."` :. .� . Phone ........... C't+A,v)LE/1", t�,nl►,ra J��%tS .n!o,z B.kNA:w4y OG3(,v... Phone �(oo) �S9- 3317* Name of Architect .................................... Address .. .. ... •........... Name of Contractor 2 .5,,. c-1�,!c .1 n t:...... Address .C'A .......................Phone Pb�!' 19-s— 15. Is this property within 300 feet of a tidal wetland? * YES .......... NO .......... *IF YES, SOZTIIiiA.D TCJidI TKJSIITZ.S,PERNII'P MAY BE W4JIHM- 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 Abether interior or corner lot. ` >rnzr or r��-W/ ,�Coin ec� ,, � f S �s►„n�74i,� JCJ<JNLY (7C .��7/-wj i4' .:......... ...........P/�o 2 k�i....s.' .....S,?�:.L.�.Q... ........being duly sworn deposes and says that he is the applicant ,Name of individual signing contract) ibove named, C7 GV A/E Q ieis Lite .................................................................................. (Contractor, agent, corporate officer, etc.) )f 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 hisknowledge and belief; and ]iat the work will be perf6med in the manner set.' forth in the application filed therewith. )worn to before me this Z p p p Oc-It7R3ec ........ �.......day of ..............,...t9........ Notary Public &W �ARS ........... ,¢ e°.............PATIRICIA H (signature of Applicant) NOTARY PUBLIC MY.COMMISSION EXPIRES DEC.31,2002 0;3/14/2018 11:55 6317885600 Z AND S PAGE 02 1l 4 �y5f SOUr�, To"halt Annex Telephone(681)765-1802 54375 Main Road I g P.O.Box 1179 rQ er.rlGhert wn15outtiso. ?d.ny.us Southold,KY 11971-0939 • I BUILDING DEPARTMENT APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: , 4 Name: License No.: _ Address: ms t I' Phone No.-t JOBSIT INFORMATION: ('Indicates required information) *Name: 1 *Address: /a JYV *Cross Street: *Phone No.: ; Permit No.: Tax Map District: 1000 Section: 10= Block: Lot: , *BRIEF DESCRIPTION OF WORK(Please Print Clearly) s (Please Circle All That Apply) *Is job ready for inspection: YES NO Rough Ir✓ Final *Do you need a Temp Certificate: YES NO Temp Infonnnation (if needed] *Service Size: 1 Phase 3Phase 100 150 200 300 3iP0 400 Other *New Service: Re-connect Underground Number of Meters Change df Service 0v (W Additional Information: PAYMENT DUE WITH 6,PPL CATION �- 82-Request for Inspection Form Deborah S. Shillo 26 Highwood Road Bloomfield, CT 06002 October 18, 2000 Mr. Gary J. Fish Town of Southold Office of Building Inspector Town Hall 53095 Main Road Southold, NY 11971 Re: West Street, Fishers Island, NY Section 9, Block 4, Lot 8-2 Dear Mr. Fish: Enclosed are the following: • Application for building permit with fee of$ 75.00 for the renovation of the first and second floors of the West Street residence. • 3 sets of plans Thank you in advance for your cooperation and please call me at (860) 242-2514 if you have any questions or need additional information. Very truly yours, Deborah S. Shillo JAN-31-01 09 : 15 AM CHANDLER PALMER AND KING J r.-,A JAN ° CHANDLER, PALMER Architecture. Engineering and Surveying 110 PROADWAY MORMON. OT 00300 (680)00-3307 G.I1°.K. 1�AX (86®)886—'T 801 � I'A451MILI! TgANSMITTAL DAT9: v ZOO TO, 6 ron o 1 Ia N.O. OI'" PAGES, (INGLUDIND THIS PAS, REMARKS.- eW,(osLL �,rc ezw cs d f t4t^% d-� .SkAla s+.t .cc ��► Cx+C'r%"Vw w-alis am ,6etns tx �s tG41r6tVeS bd j C' .c ok CC r^s IF YOU ®O,NOT MWEIN2 ALL THE PA6L5 AS MICAT AW-M, PLEASt GALL A5. DON AS POSSIBLE. gr,--a,, CHANDLER, PALMER �4, fGIN- }J KRUTER Q)[F TrNIMMUMQL =�=� Architecture, Engineering & Surveyir g: ' 110 BROADWAY NORWICH, CONNECTICUT 06360-`4482^ _ ____ PH 860-889-3397 FAX 960-686-7801 - � �._ DATE._ / JOB N0. =ATTEN J TO WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: El Shop drawings A Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution X" As requested ❑ Returned for corrections El Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO �Q/� SIGNED: G®r If enclosures are not as noted,kindly notify us at once. pF SO�Tyol 0 Town Hall,53095 Main Road Fax(631)765-9502 P.O.Box 1179 G Telephone(631)765-1802 Southold,New York 11971-0959 COUN N,� BUILDING DEPARTMENT TOWN OF SOUTHOLD June 5th, 2006 Deborah S. Shillo 26 Highwood Road Bloomfield, CT 06002 RE: West St. SCTM# 009 0004 008.002 Dear Ms. Shillo, Please be advised that your Building Permit#27075 issued Feb. 16th, 2001 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit, please submit a fee of$397.60 at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions,please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT. Southold Town Building Department guFFOi,q�c P.O.Box 1179 \` 'QUA oo Permit#: 32184 / 53095 Main Rd y Southold,New York 11971 Permit Date: 7/5/2006 V��j0 �o� (631)765-1802 Expiration Date: 1/5/2008 Parcel ID: 9.4-8.2 BUILDING PERMIT RENEWAL LETTER Dated: 9/9/2015 Applicant: DEBORAH S SHILLO Location: WEST ST FISHERS ISLAND Work Description: HISTORICAL ALLTERATION OF AN EXISTING RETAIL STORE TO A 3 BEDROOM SINGLE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES 27075. A FEE OF $397.60 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: DEBORAH S SHILLO Address: 26 HIGHWOOD RD BLOOMFIEL, CT 06002 The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building Department, P.O. Box 1179, Southold, New York 11971 THANK YOU, SOUTHOLD TOWN BUILDING DEPT. �O��pF SO(/ryolo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ,r Southold,NY 11971-0959 COU May 2, 2016 BUILDING DEPARTMENT TOWN OF SOUTHOLD Deborah Shillo 26 Highwood Rd Bloomfield, CT 06002 RE: West St, FI TO WHOM IT MAY CONCERN: e Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy Engineer required to certify septic system and all work performed under this permit. Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate.> A fee of$50.00. Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84) Trustees Certificate of Compliance. (Town Trustees#765-1892) Final Planning Board Approval. (Planning#765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Final inspection by Building Dept. Final Storm Water Runoff Approval from Town Engineer BUILDING PERMIT - 40221 —Alteration of Retail Store '43114/2018 11:55 6317885600 Z AND S PAGE 01 l & S Contracting, 111C, Fax 'T smitta1 Tel: (631)788-7857 Ftc: (01) 7WS60 zli�ds � .met I date: CcE lcQ Time Sendig �-- 1 Fax # entt 9So a- From Pboue i i Number of pages tnnsitted iuciudg this page Nies« e r r D� i COR nation required yes �' No � Special Wtructions Please Note: P d da not receive A of Se pagN a indie d above,ple�e can�� � � as Book as j CONSENT TO INSPECTION DEBORAH S. SHILLO , the undersigned, do(es)hereby state: Owner(s)Name(s) That the undersigned(is) (are)the owner(s) of the premises in the Town of Southold, located at 102 WEST STREET , which is shown and designated on the Suffolk County Tax Map as District 1000, Section 9 ,Block 4 , Lot 8.2 That the undersigned(has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: CERTIFICATE OF OCCUPANCY That the undersigned do(es)hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application,including inspections to determine that said premises comply with all of the laws, ordinances,rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances,rules or regulations of the Town of Southold. Dated: 1Z/ Z 01 Y �f � ,o•ted'" (Signature) DEBORAH S. SHILLO (Print Name) (Signature) (Print Name) 1 Deborah S. Shillo 26 Highwood Road Bloomfield, CT 06002 September 7, 2018 Town of Southold Building Department SEP 1 2 2018 Town Hall Annex 54375 Main Road PO Box 1179 BUILDINGDEPT. Southold, NY 11971 TOWN OF SOUTE[OLD RE: Application for Certificate of Occupancy Permit No. 40221 TO WHOM IT MAY CONCERN: Per your final inspection dated 6/13/18, enclosed are the following: • Final Inspection Permit No. 40221 • Board of Health Survey (2 copies) • Electrical Certificate • Lead Solder Certificate ' • Application for Certificate of Occupancy • Architect's Letter of Certification —Evelyn Cole Smith Architects, LLC • Consent to Inspection • Check for$50.00 Please call me if you require additional information. Very truly yours, 'eJ ,4 , Deborah S. Shillo Enclosures Ob�22�00 10:42 %Y860 677 6546 HARPER-W.HITFIELD- SKETCH OF THE PROPERTY SCHEDULE "B" _ - ..�_ i•ao�a �. aL. Ory 5o'E __ .� . . .. - 10l.•3� u Ji f - L\ 0•. LJ Gcormiz-++G 0 - , �,ar�.cv i�1Jr..►C�v�+rno.J 1 Ka+J ��rg •r r f OF NEIV y po H,sr q . ��•►, tio.pa95'C� FQ 4AN0 9u V!L_►.J'���rC �r� C+.1G . 1 � l�lov�►.c-e��, Z.�19�1�--- 4 C1 CL r E SINGLE FAMILY RESIDENCE y� C ,r, m a E r MUNICIPAL WATER N'� Lu 'C E C.0 tN= m ON SITE SEPTIC SYSTEM "EST n co C3 - m E COMMERCIAL BUILDING sTR ET 1: W Q d ,w APPROX LOCATIONMUNICIPAL WATER 3 \•19, 4 Q °� i EX ISTING WATER MAIIJ� SEPTIC SYSTEM SITE— tp U o 0 cam; IU�h. 9L 4� Q -5.1, U "! DRILL HOLE�w 2 P \ QE 3 W (BURIED w ¢POLE Y \ / G• g3N 2642 54 BENCH MARK Iv��Iv_ / :59 y \> W N m W 2525 63 IRON 28 w��w�-- m °� T vu `� N E LANDSCAPED o AREA I ? J WOOD 1r1/ V FENCE �•, WEST 1�1 _5 . 1YP) I STREET \ S 82 09'50" _ fo CB APPROX LOCATION LANDSCAPED S,, \ 106 331 Tr=_r.9 EXISTING WATER SERVICE r AREA ( y LOCATION MAP SCALE 1"=400' • °� \ / J , FUTURE 90 67' 1 EXPANSION POOLS(2) \ 9t NOTES J \ I INDICATED HEREON ANY EXTENS1, THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE 5-2'HIGH / < ION OF THE USE BEYOND THE LEACHING RINGS /� s PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE ENGAGEMENT I 6 7 \ 2 IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON.UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY i 3 1000 GALLON3 O O 5 (`/ % 3 ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SEPTIC TANK- _ • SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL 2 10�, •-__-_,.r 1 ARE THE PRODUCT OF THE LAND SURVEYOR I I i B/ C/F --S-j I LyJ 4 COORDINATE DISTANCES ARE MEASURED FROM U S COAST AND LANDSCAREA� I1 O PED F GEODETIC SURVEY TRIANGULATION STATION "PROS" A / / / ' i — z 5 SITE IS IN THE TOWN OF SOUTHOLD. COUNTY OF SUFFOLK TAX HENRY L FERGUSON l VILLAGE GREEN SHOPS LLC MAP 1000, SECTION 009, BLOCK 4, LOT 82 MUSEUM, INC / /" 3 r COMMERCIAL BUILDING I Q / MUSEUM BUILDING - MUNICIPAL WATER 6. TOTAL AREA = 0 343 ACRES MUNICIPAL WATER 0 / / o, i ON SITE SEPTIC SYSTEM z 7 SITE IS LOCATED IN ZONING DISTRICT HB ON SITE SEPTIC SYSTEM PAVED 2 ST RY / - c i 8 ELEVATION DATUM- NAVD 1988 Z DRIVE RESIDENCE W/BASEMENT O 3 MS 1 (n BEDROO /'9 I I 3 j oN` FF 303 / n• RECEIVED -i YQ /223 / n - -' ! rr U Lil = o O m w SEPTIC SYSTEM LOCATION DATA BRLINE / / / / / I NMI � 2018 Z t- � L z J DISTANCE DISTANCE DISTANCE 25 e'�� I O o (n F p W LOFCAOTON LOCATION LOCATION ��Wp p' < Q W Z ~• POINT y ; I 0.1 UFF.CO. HEALTH SERVICES s D_ = 3 n cn HOUSE PORCH PORCH DESCRIPTION T WASTE Q N STEPS , I OFFICE v0A�3 @ ER NIGT.. Q D_ p (n CORNER CORNER CORNER 13'-10" TANK INLET COVER { I 4 � � w � TANK OUTLET COVEREIm 4 U 3 17'-9" 46'-8" LEACHING POOL#3 Ljj Q 4 16'-9" 41'-7" LEACHING POOL#4 �^ ' 5 12'-2" 35'-6" LEACHING POOL q5 a- 6 22'-9` 47'-10° LEACHING POOL Q6 7 18'-9" 37'-6° LEACHING POOL Q7 3 o D SEPp j Q m 1 2 2018 LEGEND n PROPERTY LINE Z ABUTTERS LINE I . y� EDGE OF PAVEMENT w ]JU �1'1�Tf">f DW - EDGE OF GRAVEL ___________________ v a TOWN i�:Ia ��p� RETAINING WALL _ p.g 1® 1�F 17®V aJa+®L!V FENCE ❑ W TREE UNE OVERWIRES o/w w NOW OR FORMERLY N/F O r -•}�},�° _ UTILITY POLE t a BOUNDARY POINT O t d `r,_• .I ii •.l. �)Lry�_Si3`_•:�`��toJ6 ® F.l REALTY HOLDING CORP _ < Ho COMMERCIAL BUILDING ;i�.6.;`r'i 1 r• '� < r• o MUNICIPAL WATER ON SITE SEPTIC SYST SITEEM �i•[, ,�, • '•_', _ ':`I}� "'r': f NO ao59� \� 1 r_V1 2015 .i.s. i <.I, i4f�J.��D�`I�� ®O3� m0 - FD "e E4:, 72Y1?.-Cn d"4;rjo.r^j ai!')-ner r-,zrl!'y'fnlllt[+�.':"I l'1:: - DATE 10 q FO (- �� F 7�q S /25/2017 fa`s�.�u�l$�iJltGty f-r,/i�F'.idJ'�lif7�3vSY7��('� IJCFJf\vti.1�Ul:�, SCALE 1" = 40' QUALITY CONTROL CERTIFICATION / •' � �h"p��",Lo 'o. 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