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HomeMy WebLinkAbout10303-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southoid, N.Y. Certificate Of Occupancy No. Z10259 Date November 17, 1980 THIS CERTIFIES that the building ................................................ 120 West Mill Road, Mattituck, N.Y. Location of Property House No. County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..J..t~..e..2~., ......... , 19.79pursuant to wh/ch Building Permit No....~.Q303..Z .......... dated . J.l,l~'. 1.O. .................. 19.7.9, 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 ....~ ~':... ~.. P~.lva.t.e .0ne.-.F. emily., l:~.elltng ............................................... The certificate is issued to . . V.,..Gall.arlo8 ...... [o'vC, n'o'r'~ .................... of the aforesaid building. Suffolk County Department of Health Approval . ,9/1.7./80..-..Rob.e~t./~..Villa.. -9.-50,-5.7 UNDERWRITERS CERTIFICATE NO.. l~I. 69./4.7.~3 ...................................... Buildi/fg Inspector Rev 4/79 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10303 Z Permission is hereby granted to: ...................................... ~...*...~..!..7.,.:::. ~..(~ ...... ~-o ........ .~..V.J.b,.~. ......... ..A ........... ~.C .~:. ~ :.?.~.!.:'..,....'..~/. ........ .~.:Y..~ ........... ~.~.~,:~ ........ ~ ................... at premises located at ........... /...~...~.. ........... f:.~...~...?...7. ........ ..~.?.../..Z...~ ........ .~.../:...~.!..~.. ............................. ................................................................. ......................................................... pursuant to application dated ............................ Z~...~..~:.......~..,.?.., 19.?.~..., and approved by the Building Inspector. Fee $..../.....'.~.....= ..... /£co . / ~ ~ - q- 2__ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N4Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal), 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect ot' Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings ot premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1, Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ./,/~./~.7../~. ~. ............ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Pr°petty ~o'u' "~"/~se/(/o. Ge ~- Az'(? ~ ~...,~j~.. :%.. Street Hamlet Owner or Owners of Property . ~.]:..~./.,~..~-:..~. ,/.~..~,Q.~ ..................................... CountyTax Map No. 1000 Section . ../, ,~ ........ Block ..... ~.' ....... Lot. ?~(~'/~ ~ Subdivision ................................. Filed Map No. , .......... Lot No .............. Permit No. /.O..~. O. :~.. 'Date of Permit ?. ?. ~ .... Applicant, ', ,~-¢~..~ ................ Health Dept. Approval... ~/~/./..~/~. P. .......... Labor Dept. Approval ........................ Underwriters Approval . .. ~..~.A .~/,Z/. ~..¢ .......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ;.~ .('~ ........... Fee Submitted $ .... .~...'~'..~.~. ................. Rev. 10-10-78 Construction on above described building and permit meets all applicable codes and regulations, Applicant . . ~ ,~.~ .......... NE\~ YORK STATE DEPAiYfl~NT OF ENViROt~-~NTAL CONSERVATION Regulatory Affairs Building 409 SUllY Stony Jrook~ NY 11794 (516) 751-7900 Robert Fo Flaeke Commissioner A COPY OF THIS~,v~m~ov~v~~v~=~_ ~ i~ST ZE AVAa. LABLB~ ON PROJ~C,,~ ~ w SITE June 18~ 1979 Ulysses E~ Gallanos 1995 Broadway New York~ No Ye 10023 15272-0117 TIDAL WETLAi~DS NOTIFICATION LB_£ER APPP, OV~JL Dear Sir~ This is to inform you that we have reviewed the notification letter (or permit applisation) filed on 5/28 19 ~gand have determined that it will not be necessary to file a permit application (or secure a tidal ~etlands permit) to move a o~e family dwelling to parcel southside Mill Road~ (near Luther's Rd~)- Mattituck~ Town of Southold~ Suffolk County~ N. Y. Ass~ing you have obtained all other necessary permits~ ye~ may proceed with your project adhering to ghe special conditions (if any) found on this Home is to be a minimum of 75~ from line of Mean High Water° Att: Receipt ~{~ U 13516 DJL~cg c.c~ LAW ENFORCEMENT ac: U.S. Army Corps of ~YSDEC Law Enforcement - Region December 3~ 1950,. Region No,: Apphcant: NEW ¥OR~< S'FATE DEPARTM£NT OF ENVIRONMENTAL CONSERVATION UNIFORIVt PROCEDURES AC%, ONE Office: E}T¢. ANiqLYSZS UNIT Amodnt: $25.00 Application Identification No,: Tidel Wetlageds 15272-0117 Permit Type: Check ~] Money Order [] Check or M.O. No.: __ 24.9 FROM: WILLIAM H, BA~RON DATE:_..~LL~e_~ 30 , 1983 ATTENTION: TO: ~%ding Depa~tD~t Town of Southold Main Road South~*~NY 11971 SUSJECT:_.~_~y~S E.~Gallanos 120 West Mill Road ~ttituck~N~ I would appreciate you~_.ppu_~te_ _~S~?~._~in .p~ovidin~e with ~_ ..... c~f~ified cop~'~'{~- ~ertificate oif Occupancy for the above captioned premises. I have enclosed ~y check to ~our order in the sflm~'bf $1.00 f0~- ~Tha~nk=~ou--~'-~6~~youF c~0~{~s~es ~ and prompt attention to this request.~ /. . . // - -I Approved .~.~.~... f.~..., 1'9-~.41 Permit No ..... -: ...... Disapprove~ .... ~i~' '--' ~-7; >h ....................... APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL .. SOUTHOLD, N.Y. 1197~ o · TEL.: 765-1803 ...... Appncauon r~o./ ........ T- ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 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 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 D~l~a~n~e~ ~o~the issu~t~f a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk ~ounty, 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 premises and in buildings for necessary inspections. ....... (Signature of applitc~a corporation) (Mailing address of applicant) / State whether applicant is owner, lessee, ~en,t, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises....~. ~.....~/..~.. ,~..~...~..~...t~..~. ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .... ...................... (Name and title q/corporate officer) Builder's License No ..... /~.~. ................. Plumber's License No ......................... Electrician's License No ....................... ~ .?~ ~ ~,.~m,.o~x Other Trade's License No ...................... 1. Location of land on wh ich proposed work will be done' . . ff~/'~ ....... /~q$'7"i ......... /l~ll"~' ......... ~.Z) · ................ ~/'~,,41T/~-~ House Number Street Hamlet County Tax Map No. 1000 Section ?/ L~ Block .~. Lot. Subdivision. ap No Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existi~g.~n (~xup~ .......... ~ ..................................................... b. Inten pancy ..................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work..,~.~ (Description) ~ · _,~ .o oo ~ o~ //..-~.. 4. Estimated Cost ...................................... Fee .................................. (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 ............... tteight ............... 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 ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... . ................... ; ..... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone 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. STATE OF NEW YORK, S.S COUNTY OF ............ ~'~. ,'7~7 ~. "' ... ~....o~....~L-,m~....~....tt.~ .................. being duly sworn, deposes and says that he is the applicant (Name of individual sign~g contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements cont~ned ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the m~ner set f~h in the application filed therewith. Notaw Public ..... ~. ~ .......... County ~OTA~y PUBLIC. Stato ol Now York Suffolk County No. S2-5792800 I:t,D. ff .$o-S"7 ..~ APPROVED AS NOTED DATE, ~ - ~ ~ .