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Home My WebLink About19670-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPART94ENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19736 DATE: February 15¢ 1991 THIS CERTIFIES that the building. Location of Property 7555 MAIN ROAD House No. County Tax Map No. 1000 Section 122 Subdivision ALTERATION LAUREL ~ NEW YORK Street Hamlet Block 6 Lot 31 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 13~ 1991 pursuant to which Building Permit No. 19670-Z dated FEBRUARY 15¢ 1991 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 ALTER OFFICES FOR COUNSELING SERVICE AS APPLIED FOR. The certificate is issued to PARVIZ FARAHZAD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF2tLTH APPROVAL UNDERWRITERS CERTIFICATE NO. N-171693 - JANUARY 30, 1991 PLUMBERS CERTIFICATION DATED Building Inspector Rev. 1/81 ?OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING i'E~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: (~ ' ~-~ , ........ t..~...~~~ ...... ....~.~..~....~~...~.:~.:...!.!.~.!..o.~-~~ (-~ __ r~ ' ~ ~ l U /~ ~ ~.....~,~.~v,~.....~.....;;~ - ~, , . - ~, - , - .. . . ................... :.......: ........................ ~ ............ ,~ ......... ...: ..................... at prem,ses located at ....~.~'..~..~ ........ ~[/~...a~..~ ........... ~.~.C.~. ................... County Tax Map No. 1000 Section ..... /....~.....~'.. ....... Block ..... ...~....~. ....... Lot No .......~..J .............. pursuant to application dated .....~..~ ....... [..~. ......... , 19..~./...., Building Inspector. and approved by the Rev. 6/30/80 Form No. 6 TO~fN OF SOUTNOLD 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 *inspector ~ith the following: for new building or new 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 fro~"plumber cert%fyin~ that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings znd installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. 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: I. Accurate survey of property showing ali 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. 1. Certificate of Occupancy - New dwelling $25.00, Additiohs to dwelling $25.00, Alterations to dwelling $25.00, Swimmiz]g pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupaecy on Pre-existing Building - $100.00 3. Copy pf Certificate of Occupancy - $5.00 over 5 years - $I0.00 4. Updated Certificate of Occupancy - $50.00 5, Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date FEBRUARY 15, 1991 Construction ........... 01d Or Pre-existing Building ....... .......... )cation of Property 7555 MAIN ROAD LAUREL, N.Y. House No. Street Hamlet PAR¥IZ of Property ,nty Tax Map No 1000 Section .. Block Lot ............. division ..................... Filed blap ........... Lot .... 1967o-z hit No ................ Date Of Permit ................ Applicaot ....................... th Dept Approval .............. Underwriters Approval .......... ning Beard Approval... ................... .. est for: Temporary Certificate ........... Final Ccrticate ........... iubmitted: $ ....................... PARVIZ FARA~ZAD ql qo. ' ' ............................................... 1 9.3G APPL CA rr FOUNDATIOM ( ~ st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: I I NORTH FORK COUNSELING PROGRAM PD laox t418, 755,5 M,qin ~ld, Malliluc, k, NY 11952. (516) 298-8642 FAMILY Exoculive D,rector REINHARDT VAN DYKE. JR , CSW, ACSW SERVICE Associate Director for NFCP LEAG U E ~""~ ~. w~,~, ~w, ~sw OF SU~¢O~K COUNiY iNO S~pervisor KAREN L MALCOMSON, R,N,, Ed,D, C S. JANUARY 15, 1991 Mr. Parviz Farahzad Miller Place Estates/Little Rock Construction P.O. Box 532 Miller Place, New York 11764 Dear'Parviz: As per our conversation, I have contacted the Building Department and have been iustructed that it is your responsibility to get a Building Permit and then file for the Certificate of Occupancy. This matter requires your ursen~ attention. It ia a very serious matter for us not to [lave the proper documents for operation of tbis state-licensed men- tal health clinic. The information that you need to submit is outlined on both applications. Please contact me Immediately conceruiag your progress iu this matter. Sincerely, Karen Malcomson, R.N., Ed.D., C.S. Clinical Supervisor KM/arb Enclosures CERTIFIED MAIL RETURN RECEIPT REQUESTED Funded by lhe Suffolk Counly Department of Health Services, Division of Community Mental Health and the New Yolk State Office of Mental Health; certified by the New York State Office of Mental Health. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL.: 765-1802 ,' , "- /stuu Approved ~.~.J..'SN~. ~44t~J.g., 19'}1.. Permit NO ........... Disapproved a/c ..................................... BOARD OF HEALTH 3 SETS OF PLANS 5.~0 g... . c. EcK · ..... SEPTIC FORH ..'f ........ NOTIFY: CALL ................... MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 must be drawn on the diagram which is part of this appli- cation. c. The work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy shall 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 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 comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premmes and in building for necessary inspections. (Signature of applicant, or name, if a corporation) ?.,. ?. ,?.,¥Y. 3. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...."P.~.$. yI-& . ~..rg .~cq./J .4 .'q..~ ............................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No .... c9.../-~.. 7."~.. ............. Electrician's License No.. 1 .~.~ l ............... ther Trade s License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section . . .1~ .......... Block ~ Lot. ~[ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~'~ ................................. b. Intended use and occupancy ~¢~ ~5...~ ~.. ~.~.~...~ ~ ~.~ ....................... 3. Nature of work (check which applicable): New Building Addition .......... Alteration . !... 'i' i... Repair .............. Removal .............. Demolition .............. Other~. e.l~r~. ~i;:,}.. 4. Estimated Cost ...................................... Fee . . .~ .c>.O..'..O.c~.;....'~w.; ............. : ' ' 'i' ' ' (to be paid_o.ntliling 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 . ¢.Fff3..c~S. ............ 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 ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... . 12. Does proposed construction violate any zoning law, ordinance or regulation: ...J~9 ............ 13. Will lot be regraded ..... IQO ..................... Will excess fill be removed from premises: '/~ 14. Name of Owner of premises Deazy.~ .z.. ~ .~p~.z..~..,'~.. Address (o. ¢q'rp~.~0t .~Tp*,~' .~¢Phone No.~.~.~:.~ .gq~. ...... Name of Architect - Address ................... Phone No ................ Name of Contractor . t>~t.~.z. ............ .~a~.~. ~ Address .......... '.' ........ Phone No. ............... 15. Is this property ~ithin 300 feet of a tidal x*etland? *Yes ........ No..~. ..... *If yes, Southold Town Trustees Permit may be required, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, 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 filed therewith. Sworn to before me this NOTARY ~Ufltt{', ~tate.o! New Y0dl ............ x.: ............. 3[: ' ' ~' ' ' ~ ....... m. 4i b, a ~ u~0,k C0u,t'e~ (5~gnatlai~,,ef applicant) tam f.~p~res Nl~ch 30, lO