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Home My WebLink About20301-z f FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20535 Date FEBRUARY 18, 1992 THIS CERTIFIES that the building ALTERATION Location of Property 7555 MAIN ROAD MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 122 Block 6 Lot 31 Subdivision Filed Map No. Lat No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 21, 1991 pursuant to which Building Permit No. 20301-Z dated NOVEMBER 29 1991 was issued, and conforms to all a€ the requirements n£ the applicable provisions of the law. The occupancy for which this certificate is issued is ALTERATION FOR A DENTAL COMPLEX ZN EXISTING PROFESSIONAL OFFICE A5 APPLIED FOR. The certificate is issued to PARVIZ FARAHZAD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - FEB. 18 1992 PLUMBERS CERTIFICATION DATED DEC. 11 1991-RALPH RANDAZZO PLBG.&HEAT. ' - wilding Inspector Rev. 1/81 I' T08M NO. f 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) N 2 0 3 01 Z Date .~.~:~:~,~re:~.........a q.........., 19.~.~. Permission is hereby granted to: ~~~Jti4sh!:t:3.R........ ...U.........~........... ....................1.............. of Premises locoted at ..~..,1~5............~:^.^-:...~~~.~ .............~,.~,1:':';r`:'s...................................... County Tox Map No. 1000 Section ate.((...-~.. Block ~.~4........ Lot No.... pursuont to application doted ......r'.Y :y`~:~A,..... 19.q.~..., and approved by the Building Inspector. Fee S. Bui ng Inspector Rev. 6/30/80 Furm No. 6 ~gy_~~ p o ' TOIJN OP SOUTIIOLD / ~ BUILDING DGPARTNENT ' ~1"' TONN HALL ~b'~Ii 3~ r~,.' 765-1802 tlbdAq,~ ~ ~6,.f IA APPLICA~'ION FOR CERTIFICATE OF OCCUPANCY Tliis.application must be filled in by typewriter OP, ink and submitted to the building inspector with the following: for new buildin;, or new use: 1. Final survey of property caith accurate location of all buildings, property lines, streets, and unusual natural or topographic features, 2• Final Approval from Health Dept, of water supply and secaerage-disposal(S-9 form). 3. Approval of electrical installation Crom Board of Fire Underwriters. 4• Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 17 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. s. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses; 1. ,lc curate 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 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 I're-existing Building - $100.00 3. Copy oC Certificate of Occupa~icy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date :cw Construction........... Old Or Pre-existing ~~jj 6 Building„ ocation of Property !~.'~9l~ •?,Us~......... • re L House No, Street " " n Hamlet nwcr or Owners of Property,.., PARVI~••.~~A.~I.~A~ " uuncy Tax Ffap No 1000, Section. , ,r~ • • ~ • ~ • • ......B1ock...~...........Lot..; ~ ~ ubdivlsion...... /~n9 .....................//.//....Piled Prop.. .Lot.. ' • • • ..Date Of PcrmiC. .Applicant..........., ~aleh Dept. Approval... " ••••••••••••••••.Undenariters Approval....... .~uning Board APprnv;il quest for: Temporary Certificate...... Final Ccrticate........... c Submitted; y33s3 G~ ?~S. • ~Q ~a~oS~ . •APPLIC,IST e a , c~~FF~~I(L, TEL. 765-1802 0~0l,~, D? TO'SY~N OI' SOtJTF30~.D fa ~ . ~ ~c OFFICE OF BUILDIDIG INSPECTOR ~ u;' o +y.Y:~, v, ,~Y~, ~ P.O. BOX 728 ~ TOWN HALL ~yyo,~Q~ SOUTHOLD, N.Y. 1 1971 C E R T I F I C A T I O N Date ~ 2 / 9s-i Building Permit No. ~ r Owner ~~•e~lll Z ~-cti~-c'~~~-z~<-~.-.. (please print) Plumber i?JN / PLrs9 v~//j, SP~u. /.eC please print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. _ 1 plumber's sig ure) Sworn to before ~ this day of ~~OL lY1IjQ?,~ ~ Notary Public Rotary Public,_ County NO'f pRVpPU8E1C, M.aMI°1 ENew ~Vlfo~rk CertiOcaYe Suffoak Couet~ , Quahtied ,ues Feb 3, 19 Comm~ssron Exp - --oho THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ 1ta,I~i ~wJ„J 6UREAU OF ELECTRICITY 11- 8S JOHN STREET, NEW YORK, NEW YORK 10038 Date 'v^F4M3Tt(IF1FtY t J.~4J.~ APP(ication No. ort file Q~~yy}(~Eb~~/~~) is .'{.~.r9Ll~Q THIS CERTIFIES THAT only [he electrical equipment as described below and introduced 6y the applicont named on the above opplication number in the premises of 'Z't71'A1, LTE:PlT1+4L (",AF?[G ri55 2~i71'1 +1ddJ) h;T. 7."~ Z1F!'J`4`:CTUCIi 3v".5''. _ in thefoflowinq location, t ~ Bosement {st FY. ? 2nd F'l. t Section Block Lot was examined on H']."i`".JJilJ~.f`~t' 1~ r :L~t9~ and found to be in cornplianee with the requirements q(this Board. r• FI%TURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING PECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER ANi N W AMT. K W AMi KW AMi K W AMi H P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gELI UNIT HEATERS MULTI.OUTLET DIMMERS AMT K. W. Oll H. P. GAS H P AMT NO. A. W. G AMi AMP qMi. AMPS, TRANS. AMT H p SYSTEMS qMi WAiiS NO. OF FEET s ~ ~ a U ~ ~~a SERVICE DISCONNECT NO.OF 5 E R V 1 G E C PMT. AMP. TYpE METER ~ H, ]W ~ ~ JW 3 A 3W 3,a 4W NO OF CC. COND A W G NO. Of H4lEG A W G NO Of NEUTRALS A W G. EQUIP. PER e' OF CC COND OF HbtEG OF NEUTRAL OTHER APPARATUS: - rat~~~~tac~ vp;~.r.l F~tc~~;s-•2 Fr1R~'&LtfvOAl'~C),3s1-3 CT.tIt. E.T.~F.C. WA'1a1R H[~Ar(`FR"i r v 1'"~„ 5 SC.49. H07,SA.A'k' m7,1jC'S'f2T.G l:rTC. B~#:~1_.B 1101 V.A1,BR:CF: CI?[tfl'S' GENERAL MANAGER 'tFLFIiAPlt{ J:,,:C. t 2JSf, ~.1s1F3(9 Per l:t t^,~Ij This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 070 ~ z s THE NEW YORK BOARD OF FIRE UNDERWRITERS FnT~~ ~ = 10004L2 BUREAU OF ELECTRICITY _ ~ 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date It6BRURRY 2.nrL992 ApplirationNa.onfile 02665492/92 19 2,2x57? THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant homed on the above applicoeion number in the premises of TOTAL RENTAL CARET 7955 NA.IN RD (RTE 2.5~, NtATTIt'UCK, N.V. in [he following location; ? Basement ? Ixt F!. ? 2nd F'L O1)T .Srrtion B(oek Lot = was examined orr FEURUARY 1 E r 199'2 acrd found W be in conrplianre with the requirements q(this Board. = fIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDFSCENi GIVORESCENi OTHER AMT K W. AMi K. W AMT. KW AMT K W AML. H P DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT MIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W ON H P. GAS N. P. AMT. NO A, W. G AMi pMP AMT. AMPS TRANS. pMT N P SYSTEMS qMi WAiiS NO.OF FEET SERVICE DISCONNECT NO.OF S E R V I C E METER NO. OF CC COND A. W G A W G A W G AMT. AMP. TYPE EgUIP. 1 ~ TW L'e SW 9 A dW 3'e 4W PER B OF CC. COND. NO OF HI-LfG Of HI-LEG NO OG NEUTRALS Of NEUTRAL = OTHER APPARATUS: = 40 AMS~ CNNTRAL A/C UNIT-I 1 _ NOLIOAI' ELECTRIC LIC.~491.°E - 110 VALERIE COURT ~ G!~~~ GENERAL MANAGER YAPNANX If. i., NY, 1.!980 1t Per ' This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. '1~..LD~~.tiS:`PC.iu:J ~~Db;c I i;OMMENiS 7 . .m O _a ~ _ H O FOUNDATION ( 1st ) y ~ FOUNDATION ( 2nd ) inf 2 . ~ ~ of P,OU FRAME & !r,~ pL ( li,~l y 3 . ~ ~ -3 x m I17SULATIOA! PER N. Y. ~ m H STATE ENERGY CODE x 4 . , m H FIiJAL ~ ~ Ia ~ ADDIT tlAL COMMENTS: ~%T'S'/°M ~ ~ - x ~o ` ' ~ V H w m _ r ~ x 7S . ~ m,:. -o H n n ` . i ' r~ l~ i i ~'J~-~ it ) f. ~ ~ ~ y b _ eaf ' ~ _ v ~ ~ ^ f I I i ~ ' ,~~11A<<rW''"'" ur. - J~Pu• ~-J. ~.R n' - d I ~ ~ ~ r ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ~ ] ROUGH PLBG. ~I ~ FOUNDATION 2ND [ ] IN CATION [ ]FRAMING [ FINAL I REMARK ~ (a,,., 4 DATE ~ INSPECTOR BO,IRD OF HEALT}i FORM NO. 1 J SETS OF PL \:iS . r? ~ ~~fi:ri TOWN OF SOUTHOLD SURVEY _ _ , BUILDING DEPARTMENT CiICCF: , "~4'~''u~ ~ ~ TOWN HALL d3P •V"y+-,~, SEPTIC COfta . . . . `~di?-:'6S"t:' ,'~`.,l'~`_ ~ SOUTHOLD, N. Y. 11971 TEL.: 765-1802 r:oTlF~t, CALL Examined . .....a9, 19 q. ( . . . NAIL T0: Approved fJ a°l., 19 9.t. Permit No. d ~ i, i • a., . . Disapproved a/c . ~It, , , . - ~ ~f r ~ , z nay 1 . . . u ~ 6, ' lr.~~ ~ ~ 1 °F1~ a( x ppc t. li e1.1I lF t ~)~f a~~~~F i uilding Inspector) ~ ~ . _ ~ -.u APPLICATION FOR BUILDING PERMIT Cy Date 19.11 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 .ets 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 >r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. Tl1e work covered by this application may not be commenced before issuance of Building Permit. `3. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit •hali 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 whatever until a Certificate of Occupancy .hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or tegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. flte applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit au[ftorized inspectors on premises and in bui]ding for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) /!T y ga State wltetlter applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. \ame of owner of premises , ,Q, . , , , . , , , , (as on the tarx roll or latest deed) :f applicant is a corporation, signature of duly authorized officer. (Name and title of~c/orp~rate officer) Builder's License No. . d!,l,~, , , , , , , , Plumber's License No. ~(!yi, - , , , , , , , , / E•lcctrician's License No. a . Other Trade's License No. h Location of land on which proposed work will be done . . "7~35s" Ilouse Number ~~~reet Hamlet County Tax Map No. 1000 Section Block ....rP . . Lot , . , . Subdivision Filed Alap No. Lot . (Name) State existing use and occupancy ofpO~remis~~es and intended use and occupancy of proposed construction: a. Existing use and occupancy .../.!'r!"1.~.~s!Gtn. ~ , ~ b. Intended use and occupancy , , a , a,,t.id 4`i C/ ...v...?~A,x;'Ij.;en£di,':1-~-i,+.'~,..'.'•~i°,:%3't3?'iS Sfk'e(ER+I! ature of work check which Re air ( . , Rempplicable): New Building AdditiPti Alteration p oval......... Demolition Other 1Vork , . , /~d ~ _ (Descri lion 4. Estimated Cost ,r~'odYi•-- ! p ) Fee number of dwellin (to be paid on filing this application) 5. If dwellin $ units , , , , , , , , , , , , , , , Number of dwelling units on each floor , , , , , , , , • , If garage, number of cars , 6, If business, commmercial or mixed occupancy, specify nature and extent of each ty~e of use .~2~'~4tf`!s.~ , , , , , tmensions of extstin structur g Nutcs, if any: Front Rear S.Ta~ •De th ~ Hei ht ~ g nber of Stories , ,,(~!a~ ........................n................. Dimensions of same strctur with alterations or additions: Front s~!S?~',/, , , , !tear , , • , Depth ~3~':~.ti:. , , ,Height , Number of Stories , 8 Ha ~l tsions of entire new c Nu t~',ntction: Front . . . Rcar De th ° rpberofStories, p 9. Size of lot: Front Rear Depth , . 10, Date of Purchase 1 1. Zone or use district in which pr Name of Former Owner • ~ • remises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation: .......~l,~f,-, , , 13. 1Vll1 !ot be regraded , 'i,), , . , /~t`;g';`.- /~Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ; ~~!;ri~~, , ~~'.~'pwSTddress Name of Architect ''•••••••••••••••••PhoneNo...7fiY.~~'~,r-, Name of Contractor . • • • • • • • ~ ' ' • ' ' • • • Address ...................Phone No......... . ••••••••••••.....Address Phone No. 15. Is this property within X00 feet of a tidal wetland? * *If yes, Southold Town Trustees Permit may be required. No, 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 whether interior or corner lot. i~-Q~ . n TATE OF NEN R OUNTY OF . , S•~ • • • ~ ' ' • ' ' 'p' ' S ' '~'r~J~• • • • • • • • being duly sworn, deposes and says that he is the applicant (Nam~findivi~l~in contract) >ovc named. ~~JJ ~istltc ............./~,ycry~.................................... t~~~ll (Con tractor, agent, corporate officer, etc.) ' ' ' ' ' ' ' ' ' ' said otvncr or owners, and is duly ~uthorizcd to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the trk will be performed in the manner set forth in the application filed therewith. 'or to before me th/is i / ~j / .(.~..dayof,a ~U,... ,19.L1 tary Public, ! I , County CLAIRE L. OL6VI1' • • - , Notary Publlo, State of Njaw Yak No. 4878505 QualHlad In Suffolk Cggggunty Y~ (Signature of a ]rcant) Commlaakm Expkes Daoemt}a 8,19 ~ pp