HomeMy WebLinkAbout19280-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219766 Date MARCH 5, 1991
THIS CERTIFIES that the building ALTERATION
Location of Property 7555 MAIN RD. LAUREL
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 06 Lot 31
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 23, 1990 pursuant to which
Building Permit No. 192802 dated JULY 30, 1990
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 FOR PROFESSIONAL OFFICE IN EXISTING BUILDING.
The certificate is issued to PARVIZ FARAHZAD
(owner)
LESSEE--NORTH FORK FAMILY PRACTICE
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N171692 JAN. 30, 1991
PLUMBERS CERTIFICATION DATED N/A
~Q1+ ~?L
Building Inspector
Rev. 1/81
roans aro.
TOWN OF SOUTHOLD
®UILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ I `T 2 8 4e Z Dnte ....1.,1.~~ 19~,~c.
Permissi n is here y gro ted to:
.
at premises located at ....~~.~?~..~//.J~.......~•.~~~~/~J~:~'1........7.~ .i ~ fyt~
.................................................4.f ~!2;f~-Y
County Tox Map No. 1000 Section....,1.~.~.z........ Block .......X~..........ppLot No.......~jL..........
pursuant to application dated 19..P..l~., and approved by the
Building Inspectoor.
Fee Q,~,~S~
~ .,fit,.-•................
uild Inspect
Rev. 6/30/80
Form No. 6 VI C ~LSSc~i~
TOWN OF SOUTHOLD
BUILDING DEPt1RTMENT
ro TOWN HALL
FGD ~ S (Q~~ 765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
1. This application must be filled in by typewriter OR ink and submitted to the building
inspector 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. of water supply and sewerage-disposal (S-O form).
3. Approval of electrical installaCion from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 lead.
S. 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.
3. 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 Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
Fees
i. 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 - $5.00 over 5 years - $10.00
4, Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - ResidentialOO $15.00/x, Commercial $15.00
Date ....oS.l4~/~: 4 ~
:ew Construction..... Old Or Pre-existing Building
.ocation of Property,~?'~~,N,!`aieK FAmr~_1,P2~IC~~~sr~n?,arn~ S`r-.......Cl~;u.,e~~
House No, Street Hamlet
)nwer or Owners of Property..,l;4~vtZ. ~l7(Z~t}z/~
;ounty Tax Map No 1000, Section•...(.~.e~. ....B1ock.......~.......LoC...:? ~
ubdivision .Filed Map......... .n. .LoC......................
'ermit No..~~.aV.~..~.~.,/Date Of Permit.~h~~~6.......Applicant.C~~J/.~Z,.~~.~/.~:(t?:~~...:....
Iealth Dept. Approval....(/JY.~~'~ .............Underwriters Approval......................
Tanning Board Approval..:~cRt./f:`~'!G
equest for: Temporary Certificate......,..,, Final Certicate....V `
ee Submitted: $,~.V;::Q
~~/~9/ ~ APPLICANT
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S~EFflLk~`~? TEL. 7G5-1802
gyp. y,./~~ OG~, TOWN Or SOUTIIOLD
:.3'~ (.t+:~a.t UPC'ICG Or BUILDING INSPECTOR
a =`w~~{{~'~ z P.0. BO\ 728
uy ";!r•~' 'd rn
y~ ~ ~ TOWN HALL
ys/ SOUTfIOLD, N.Y. 11971
Ol
FEBRUARY 19, 1991
PARVIS FARAHZAD
P.O. BO% b63
STONY BROOK, N.Y. 11790 _
To 47hom This May Concern,
We are unable to complete your Certificate
of Occupancy because of the following reasons.
/R%/ An application for Certificate of Occupancy
• is not on Lile. ENCLOSED
No Underti~rit-ers Certificate on file.
The check is( /not on file.) $50.00
No Ilcalth Dept. Approval on file.
No final inspection has been made.
Please contact our office on this matter. '
Thank you for your cooperation.
Bui]dinrl Permit }f I 9 2 S 0 Z NORTB FORK FAMILY MEDICAL CHNTER
Building Dcpt.
/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
cc: NORTH FORK FAMILY MEDICAL CENTER
BOR 153
MATTITUCK, N.Y. 11952
. . ~ N.t . , x.~r, .w,~~~ .w sza.~~~azx
~ 7is-~N2
StItLDiNQ DEFT.
~
[ ] t~'{~INOA1h~Mf' f~`I' ] 7tOU~iN PL.BA.
FOUNDATION ~iD [ ] INSULATI~1
17 FItA [ )FINAL
~ s
J ~<i A ~cl~
DATt ~O INE~1. ~
D 60ARD OF HEdLTH
3 SETS OF PL,1NS ~•.IS~........
~y~ FORM NO. 1 SURVEY
Z 3 ~ TOWN OF SOUTHOLD CHECK . ~.`1.°I........... .
BUILDING DEPAflTMENT SEPTIC POltrt . .
LDG.DEPT. 70WN HALL
'gy'p OFSOUTFiOLD SOUTHOLD, N. Y. 11971 NOTIFY ~g~'.-
TEL.:7G51802 CALL
19~~ MAIL T0:
Gsamincd ~0 c p
:lpprovcd .....7~?d.~....., 19~~Pennit No..flc.~~U. ~ / /
Disapproved a/c 1
p . ~'~.G-...... ~1915"~
uildin [ns ector)
APPLICATION FOR BUILDING PERMIT
' ' . Date .......7.-23.-......, 1599.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
lets of plans,accuzate 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 this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector wdl issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for itrspection throu;ttout the work.
e. No building shalt be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Buildin; Department for the issuance of a Building Permit pursuant to the
Buildin; 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.
flte applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and to
ulmit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
"state whether applicant is owner, lessee, agent, architect, engineer, genera'. contractor, electrician, plumber or builder.
..............North. FOrI~`.$d01~.>,Y..1"11?.di.Ga.I. CGnt~~.. (Lessee)...............................
~`arne of owner of premises ]'drV12. F:ardh.a3d .
(as on the tax roll cr latest deed)
f applicant is a corporation, signature of duly authorized officer.
~~q=Ilr~:~ .
' (Name and title of corporate officer)
Builder's License No . .
Plutnber's License No . .
Electrician's License No . .
Other Trade's License No . . . .
~.ocation of land on which propose) work will be done. .........................'......(~J~..~.
.
7555 Main Rd: Matt
}[Ruse Number S[rcet. Hamlet
County Tax hlap No. 1000 Section , ,122 , . • , , • , Block ...6.. , 31
Lot
„ .e
Subdivision . F.ilcd M1tap No. Lot
~ (Name) ~
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
t offices
a. Existin^ use and occupancy .......~2da.cal. a£fices . vdGdlt... , .
` b. Luended use and occupan^~
..F~ma.Zy. Nl~dica.b .C~n.ter .
~ . ~
3, Nature of work (check which aQplicable): New building , Addition . A{teration . X'.'s i .
Re air Removal .
p Demolition Ot~t~,3~V,3~r~*.,,
(Dost' ~)~ion)
4. Estimated Cost .......~20,,,400 Fee , .,~C7.1R ...,.u?~-;. .
(to be d bd Gling.thls"~pp(i`c°atio
5. If dwelling, number of dwclling;uniis , .N/A , Number of dwelling units on each floor .
If gara;e, num bcr of cars . . . . . . . .
6. if business, commercial or mixed occupancy, specify nature and extent of each type of use . , Medical. Center:
Dimensions of existing structures, if any: Front . , , ,Rear . Depth .
Hoi;ltt 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 .
Hci;ltt . . ...Number of Stories , . , , . , , .
9. Size of lot: Front Rear.,....,............... Depth
10. Date of Purchase . . Name of Pormcr Owner , , .
11. Zone or use district in which premises are situated . . . . . . . .
12. Does proposed construction viojate any zoning law, ordinance or regulation :
o •
14. Namle of Owner o f remises P, , ' ' • ' ' ' ' ' • • • • Will excess fill ~e removed from premises: Ye No
p Address >?,n•>~ 663 SL-ce?y, llroolc Phane No. , 744-184 .
Name of Architect R~xt+3. •Y'?~:P."....... , Address47Fj p~resg Dr;• xt. ,Phone No..654n4?49....
Name of Contractor ......Address . ,Phone No....... .
IS.Is this property located with in,~00 feet of a tidal wetland? *YES...,NO...,
*If yes, Southold Towri Trustees Permit may be required,
PLOT DIAGRAM
Locate clearly and disfinctly all' buildings, whether existing or proposed, and. indicate all set-back dimensions from
property Gnes• Give street and block number or description according to deed, and show street names and indicate whether
interior or corner ]ot.
,i, , ~
,;w.~.,
STATE OF NE1V YORK, S S
COUNTY OF . .
r..-J...
• ~ • ~ r D~~.~:~~.
~ being duty sworn, deposes a3td says that he is the applicant
(Name of individual si~niiig contract)
abovg named.
•
tic is the , ~!~'he.'-~~.~~.~:f
. . .
(Contractor, agent, corporate nCficcr, 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 contai~tcd in this application arc 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
• i ~ 3. .day of . 19 qd,
Noft'':y Public, . It County
NELENK.DEYOE 1,•
' N01'AKYPUBt1C,SS~~tleootNewYak (Signature ofapplicant)•
Tx~m'EKptr~?h 30.
j ` ,