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Home My WebLink About34979-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33951 Date: 09/15/09 THIS CERTIFIES that the building ELECTRICAL Location of Property: 7905 MAIN RD LAUREL (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 122 Block 6 Lot 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. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3055673 06/19/08 PLUMBERS CERTIFICATION DATED N/A P Authorized Signature Rev. 1/81 1 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATIONFOR 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,stre topographic features. ets, and unusual natural or 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: i. 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 ofOccu denied, the Building Inspector shall state the reasons therefor in writing to the appli C. Fees E VU E � U E D 1. Certificate of Occupancy-New dwelling$25.00,Additions to dwelling$25.00, Alt t s to ell' Swimming pool$25.00, Accessory building$25.00,.Additions to accessory buildin 0, (0.00. 2. Certificate of:Occupancy on Pre-existing Building- $100.00. 3. Copy of Certificate of Occupancy-$:25 4. Updated Certificate of Occupancy- $50.00. BIDG.DEPT. TDWN OF SDUTHOLD 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. New Construction: Old or Pre-existing Building: (check'one) .Location of Property: House No. �� -`1 i� Street. Hamlet Owner.or Owners of Property: Suffolk County Tax Map No 1000, Section dock Lot_QED , 00Q Subdivision 'Filed Map. Lot: Permit No._ A Date of Permit. . Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: .Request for: Temporary Certificate Final Certificate: . �/ (check one) co Fee Submitted: $ "'� Applicant Signature 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 t:53 Uq (to MATTITUCK,NY 11952 for ELECTRIC WORK FOR NEW CHAIRS (TOTAL DENTAL CARE) at premises located at 7905 MAIN RD MATT/LAUREL County Tax Map No. 473889 Section 122 Block 0006 Lot No. 029 . 002 pursuant to application dated AUGUST 26, 2009 and approved by the Building Inspector to expire on MARCH 3 , 2011. Fee $ 500 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 u TOWN OF SOUTHOLD PROPERTY RECORD CARD men i2 OWNER f STREET G�3 VILLAGE DIST.1 SUB. LOT FORMER OWNER N E ACR. 13 S . W TYPE OF BUILDING RES. SEAS.. VL. FARM COMM. CB. MICS. Mkt. Val LAND IMP. TOTAL DATE REMARKS /f. Sunv e ova t 3 Prate it 3 3oo. 2 2 71271 a a t% - �a S4.0 'ce 21,; Ld ` ,, 1300 � - Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD 1 Meadowla'nd DEPTH House Plot BULKHEAD Total . n t4y , r,wr•r vr ■■■M■URM■MEMO■■■ ■ m- --g y _- - ■ .. �■■■�■ �S�■■M.M MIN■ fix.-vw ^ . ■■■■■■■�■■■�■■■■■■■■ ■MM■M■■MMM■M■MMM■■■■ t ■MMM■M■M■M■■MM■MMMMM NONE■■ ■■■■■■■I■■■■■ ■MOM■■ ■MM■■■M MINIM■■ ■■■■■■ ■■■■■■■■■■■■■ Foundation Interior Finish Fire Place Rooms 2nd Floor L •MCP '- _ 1. N) @rL3r3.rL3 @ fly,I�rJrJ�r��r.l�r lrJ�cnr lRrJ�r�rJr�cP�r PrJ�rJ�r�c l�cPr�r�rJ�r�rJ�rJ�r�rJ�rJcPcPr�rJ�rJ�r�rJ�rJ@P�PcPr.PrJ�rJ�r PrJ�rJ�r�rJrrU�r r@Pd-rJC3 Rc 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 � S 5 BUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 5 CERTIFIES THAT 5 5 Upon the application of upon premises owned by 5 � • 5 S C5, 5 GLEN'S ELECTRIC OF L.I. INC TOTAL DENTAL CARE OF MATTITUCK L� PO BOX 1304 7905 MAIN RD 5 SJAMESPORT, NY 11947, MATTITUCK, NY 11952 5� 5 Located at 5 5 7905 MAIN RD MATTITUCK, NY 11952 5 5�j Application Number: Certificate Number: 5 3055673 3056673 rj Section: Block: Lot: Building Permit: BDC: rj 5 0 ns11 5 Described as a Commercial occupancy, wherein the premises electrical system consisting of 5 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Basement,First Floor, c� 5 5 visual in f the remises electricals stem limited to electrical devices and wiring to the extent detailed 5 A vis a inspection o p y g �j 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard 5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5 5 authority having jurisdiction, and found to be in compliance therewith on the 19tn Day of dune, Zoos. 5 5 Name OTY Rate Rating Circuits Tvoe 5 e] AdditionalCharges eC] 5 install sub panel and supply powe to 3 5 dental chairs S Appliances and Accessories 5 Medical/Dental Patient Care Unit 3 0 20a Amps 5 5 Panels 5 5 1 100 5 5 5 Wiring And Devices 5 Receptacle 3 0 Gen,Purpose 5 5 5 5 5 Sea/ 55' 5 1 of 1 5 5 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated._ 5 5 5 10 �� Eu ��rJ��.r�n�n��.r�rn��.r�n�nrJar�r��rJ��.n��n��nr�rr�.n��n��t��.r�n�.r��rJ�� o TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL . Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 / ` /} Survey SoutholdTown.NorthFork.net PERMIT NO. C 'Y `f Check Septic Form N.Y.S.D.E.C. Trustees ( 2 Flood Permit Examined 2009 Storm-Water Assessment Form Contact: Approved Mail to: Disapproved a/c Phone: Expiration x ,20 010HInOS.10 NM01 Y-4 1d3G'0018 Building Inspector 6UU6 J A ATION FOR BUILDING PERMIT Date 120 Q INSTRUCTIONS 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 12 months after the date of issuance or has not been completed within 18 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 Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and of r fplicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal r d oliti n as herein described.The applicant agrees to comply with all applicable laws, ordinances,building code, hous'1g co , an egulations, and to admit authorized inspectors on premises and in building for necessary inspections. OCCUPANCY OR ALL CONSTRUCTICN USE IS UNLAWFUL MEET THE REQUIREMENTS OF TH�it re o/ applicant or name,if a corporation) CODES OF NEWU YOI R,,_.T WITHOUT CERTIFICATE ��-� 'AgC6 OF OCCUPANCY �ailing addres�\ nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder � s APPR TIED AS NOTED T B.P.# Cvl ,? Name of owner-of premises (As on the to roll o BY:— If applicant is a corporation, signature of duly authorized officer BUIL ING DEPARTMENT AT 765-1802 8 ABM TO 4 PM FOR THE FOLLOWING INSPECTIONS: (Name and title of corporate officer) 1. FOUNDATION - TWO REQUIRED kJNDERWRITERSCERTIFIG�� FOR POURED CONCRETE Builders License No. 2. ROUGH - FRAMING & PLUMBING Plumbers License No. 3. INSULATION Electricians License No. /e4 ,5 4. FINAL - CONSTRUCTION MUST Other Trade's License No. BE COMPLETE FOR C.O.ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW 1. Location land�o which sed workill lie done: YORK�f�LT E�ARRGRQ. LE FOR � GrI DESI House Number Street Hamlet County Tax Map No. 1000 Section a Block Lot " Subdivision Filed Map No. Lot 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 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work cDle c{ri 1Lg( (Description) 4. Estimated Cost Fee Sm� d (To be paid on filing 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. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front i Rear Depth Height Numb'.er of Stories 8. Dimensions of entire new construction: Front Rear A Depth_ _ Height Number of Stories 9. Size of lot: Front 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 Address Phone No. Name of Architect Address Phone No Name of Contractor 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. PERMITS MAYBE 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 NO * IF YES, PROVIDE A COPY. CONNIE D.BUNCH STATE OF NEW YORK) Notary o OchSt 8 f N w York SS: Qualified in Suffolk county COUNTY O Commission Expires April 14,70 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 Of di etei} 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 thi r day of 20 _ Notary Public Signat4LejA Appli nt SO!/ryolo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G �Q Southold,New York 11971-0959 'O cOUNTY,Nc� BUILDING DEPARTMENT TOWN OF SOUTHOLD September 3, 2009 Total Dental Care PO Box 1416 Mattituck, NY 11953 RE: 7905 Main Road, Mattituck NOTE: Your Building Permit is enclosed. Please complete the following items and we can issue the Certificate of Occupancy. TO WHOM IT MAY CONCERN: The following items are needed to complete your Certificate of Occupancy: 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. Final Planning Board Approval. Final Fire Inspection from Fire Marshal. Final inspection from the Building Department. Final Landmark Preservation approval. Building Permit : 34979-Z