Loading...
HomeMy WebLinkAbout34979-ZFORM NO. 4 TOW/~ OF SOUTHOLD BUILDING DEPAJ~TMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33951 I~ate: 09/15/09 THIS C~K'rIFIES that the building ELECTRICAL Location of Property: 7905 MAIN RD LAUREL (HOUSE NO.) (STREET) (HAMLET) Cowry Tax Map No. 473889 Section 122 Block 6 I~t 29.2 Subdivision Filed Map No. Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 26, 2009 pursuant to which Building Permit No. 34979-Z dated SEPTEMBER 3, 2009 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 ELECTRIC FOR NEW DENTAL CHAIRS AS APPLIED FOR. (TOTAL DENTAL CARE) The certificate is issued to MATTITUCK REALTY LLC (OWNER) of the aforesaid building. S[IFFOI~KCOI~YDEPART~4ENT OF H~%LTHAPPRO~-AL N/A ELRt-£KICAL c~KTIFICATH NO. 3055673 06/19/08 PLUMBERS CERTIFICATION DA'r~u N/A Authori~ Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765q802 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 °f Property with accurate location of all buildings, property lines, street~, 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 residence~ and similar buildings and installations, a certificate O£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: t. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A pr°perly c°mpleted application and consent to xnspect signed by the apphcant, if a Certificate of Occupancy i, denied, the Building Inspector shall state the masons therefor in writing to the appli ' C. Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, All Swimming pool $25.00, Accessory building $25.00, Additions to accessory buildin 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. Temp°rary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. C~C~/(~q New Construction: Old or Pre-existing Building:_ ~'~ (check one) House No. Strec! ' - ' Hamlet O erorOwne ofPrope y: L-L Suffolk County Tax Map No 1000, Section L~-~ ~q ~ Subdivision Filed Map. Lot: Health Dept. Approval: Underwriters Approval: Planning Board Approval: .Request for: Temporary Certificate Final Certificate: .. x~d (check one) fi' / Applicant Signature [12~B~inesses 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. 34979 Z Date SEPTEMBER 3, 2009 Permission is hereby granted to: REALTY L L C MATTITUCK PO BOX Z~ ~IV MATTITUCK,NY 11952 for : ELECTRIC WORK FOR NEW CHAIRS (TOTAL DENTAL CARE) at premises located at 7905 MAIN RD County Tax Map No. 473889 Section 122 pursuant to application dated AUGUST Building Inspector to expire on MARCH MATT/LAUREL Block 0006 Lot No. 029.002 26, 2009 and approved by the 3, 2011. Fee $ 500.00 Authorized Signature ORIGINAL Rev. 5/8/02 I~_.~..po.~.~._TOWN~_ OF SOUTHOLD PROPERTY RECORD CARD OWNER , STREET ~' ~ VILLAGE DIST. SUB. LOT E ACR. FORMER OWNER I N j.~::j~5~l~l~j~/ '~P~ M ~.~(3~4 S W ~PE OF BUILDING O~ MICS. Mkt. RES. S~S. VL~ FARM ~O ' CB. ~ND IMP. TOTAL DATE R~RKS ~<;'~.~ ~ ~00 ~c ", ' ' Tillabl~ FRONTAGE ON WATER ~eodowlond DEPTH House Plot BULKH~D Total ,1. Bldg. xtension xtension xtension orch ~ ~eck ,reezeway iarage LEi. Foundation Bath Basement Floors Ext. Walls Fire Place Pool Patio Driveway Interior Finish Heat Attic Rooms 1st Floor Rooms 2nd Floor BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELE~CTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by GLEN'S ELECTRIC OF LI. INC TOTAL DENTAL CARE OF MATTITUCK PO BOX 1304 7905 MAIN RD JAMESPORT, NY 11947, MATTITUCK, NY 11952 Located at 7905 MAIN RD MATTITUCK, NY 11952 Application Number: Certificate Number: 3055673 3055673 Section: Block: Lot: Building Permit: BDC: 0 ns11 Described as a Commercial occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 19th Day of June, 2008. Additi°nalCharges dental chairs Appliances and Accessories Medical / Dental Patient Care Unit 3 0 20a Amps Panels Wiring And Devices Receptacle 3 0 Gert, Purpose seal 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL . SOUTHOLD, NY 11971 TEL: (631) ~765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined C~ ~ 75 ,20Cc~ Approved Disapproved a/c Expiration 'Id]0 'gOld PERM1T NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: Building Inspector :ATION FOR BUILDING PERMIT Date INSTRUCTIONS 20__ a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 of this application, the Building Inspector will issue a Building Permit to the applicant. Such 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 the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 1 2 months after the date of issuance or has not been completed within 1 8 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Zone Ordinance of the Town of Southold, Suflblk County, New York, and ot~}e'P~l~p, ,~ :abl~ Laws, Ordinances or Building Regulations, for the construction of buildings, additions, or alterations or for removal~ r~6r de~he~:i$n]as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hobs)fig co~b, f~gulations, and to admit authorized inspectors on premises and in building for necessary inspections. OCCUPANCY OR /,u coxs ili;, ,' '%,., I~E 1(2 I IMI /5~^/C-IiI t, IEE'FTt E ©F :: 'r- :)~;'~-~.- (Si ~}~reo~fapplicantorname fa corporat on) wot- o . RE_U. ,:.,,,-, .... ;-':'(;'"?0:' ..... - . .//- WITH.OUTOCr! [ :r.!'}',. ' ! · t ~, x \ (~ailing address of~ooJ, ic~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder [ e %$ APPROVED AS NOTEg Name of owner of premises }~,._m['41'/~ //~ (As on the ta~roll o~,~~ i~[iPy ~UILU'd~ 2E-)qTMENT AT If applic~t is a co~oration, si~atum of duly authorized officer 765d802 8 AM 70 4 =M FON THE tttle of corporate officer (Name and ' )UNDERWRITERS CEflTIF,~,,, Builders License No, RE IRB Plumbers License No. Electricians License No. (__o Other Trade s License No. Location ofJa. qd on which pj;opos~d work will be done: House Number Street County Tax Map No. 1000 Section {" ~ '=~ Block Subdivision Filed Map No. FOLLOWING INSPECTIONS: 1. FOUNDATION. TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRdCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALl. MEET THE REQUIREMENTS OF THE CORES OF NEW YORK S~'&T£. ,N~T/1ESPO[gSlBLE FOR Hamlet & Lot Lot State existing use and occupancy ofpreu~ises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ ,,~.~ b. Intended use and occupancy x~}OC~ ~_a~e~-24~'~f /X~)P~ p(.~/4JCfffl~/~-~ 3. Nature of work (check which applicable): New Building. Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work ~/'~' c~r-/~.q f Fee ff'(~d~ d O (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of entire new construction: Front Height Number of Stories Size of lot: Front Dimensions of same structure with alterations or additions: Front Rear Depth Height. Number of Stories 8. Rear i ,, Depth 9. Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO 13. Will lot be re-graded? YES__ NO Will excess fill be removed from premises? YES NO__ 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERM[TS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES__ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY Ot~ ~ NO CONNIE D BUNCH Notaff Public, Sta~e of New York No. 01806185050 ~ qua ifi~ in Suffo/k County, t,ornrn~sslon I:xpires Apd114, 20! G~..._ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (Contractor, Agent, Corporate Office/', etd.) 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 tree 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 thi~ r~ .'~. day of .,~. (x~.~ 20 ~9c~ Notary Public S ignat e~x~o{ Appli0ant