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Home My WebLink About9420-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupency No. Z9050. ..... Date ... ,~.u~e...9 ................ , 19.78. THIS CERTIFIES that the building located a~ 3~5..Rochelle. P.~,a¢.e. ...... Street Map No... 7.7.0 ...... Block No ........... Lot No, . 22 .-~. Pax?c. o~..23 .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..~ugus~;.. 20 ......... , 19.7.7. pursuant to which Building Permit No .... Q420Z dated .Augu~c.. 22 .......... , 19.77., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... ACCESSORY..BU~[LD~[NG ............................................. The certificate is issued to ..... C.a~l. & .Jacquely~..Dtstel~feld ................. (owner,~ of the aforesaid building. Suffolk County Department of Health Approval .. N./.R / UNDERWRITERS CERTIFICATE No ..................... N/R ..................... HOUSE NUMBER · 3~5 ......... Street ........ [~o.e, he~.~..~:..P~-~oe ................ .............................................. M~tt~c.k,. N. ew. ¥or.~ ........... Building Inspector BUILDrlNG~ TOWN (THIS PERMIT MUST BE KEPT ON THE pP~EMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9420 Z Date ........................... ~kqg.....2~ ............ t 9...~..~. Permission is hereby granted to: Car]. Distertfeld ........................ .Roehell Plao Mattituck build new accessory storage building ..................................... _, Roche]~ Place .................................................. et premises located u, ............................................. Mattituck .. ........................................ ,~'tl~ 20 ~ 19'~.~..., and approved by the pursuant to application dated ....................................................... ' Building Inspector. lOiO0 Fee $ ........................ FOI~M NO. 6 TOWN OF SOUTHOLD Building Depa~tment Town Clerks Office $outhold, N. Y. 11971 APPLiCATiON FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector 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 features. 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 installations, a certificate of Code compliance from the Architect or 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: i. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features· 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 or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Da,e New Building ...... ..~.i. ......... Old or Pre-e~xisti~ Buj~dij~g ......................... Vacant Land ............................ o,, r o, ........................... Permit x. ~ :. ~. . . ~7 : ~ ~' Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .......~ ........................ Construction on above described building Ld_ permit m.~ al~:~olico~l~d~_Lreg~/s/ pph .......... Sworn to before me this ~// / ................ day of ............................................ (stamp or seal) Nota~ Public .................................... County IPOBM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined .................. ,~.~ ................... proved ............... ....... ?.2. ........ 19....L: ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. Dot, .............. , a. This application must be completely filled in by typewriter o~ 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 o~ areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. 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'~,l 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 premises and in buildings for necessary inspections."'-~, ......... ........ ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ ............................................................................................................................................ Name of owner of premises C~- J J~J~ . ~)I~J~¢,~'0e-- lc:L_ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which propose.,d work will be done. Map No.: ..~.!.1..~...~...~,...~..[_~...~..~.7..O. Lot No. Number .~.~.'~ S~]~ ],~/c~_. /,~,~ /./././././././././~/~ ~ ..,L~!~...). ,/:~.,~.A/~-/c~,~Ac Street and .......................................................................... .C. ................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .............. .~...~. ....................... ~. .................... [ ............................................... I~,11~ b. Intended use and occupancy .................. ~"3' .................... /' ................... ~...~...~.:.:.m:(] ............................................... 3. Nature of work (check which applicable): New Building' .......>~ ......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) (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 occupano/, specify nature and extent of each type of use ................. T ......... 7. Dimensions of ex)sting 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 Height ...... ~ ...........Number of Stories ..... / ........................................... ? .................................................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regutation: ..I~¢ ................................................. 13. Will lot be regraded ......I~..~ .................. Will excess fill be removed from premises: ( ) Yes (X) No ]4. Name of Owner of premises ..~.. .............. ~..,.//. ....................... Address ................................ Phone No ....................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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, N STATE OF NEW YO~K~_f~ ~ COUNT~ OF ....... ~,~,~L.~.... ~~'~ . .[~..,..~(~2.6~.f. ......................... be n0 duiv swom~ deposos ond s*ys that ho is the (Name of individuol si~nin~ controcf) above named.~, He is the .......... ~.~f.~c.~ ................................................................................................................................................ (Contractor, agent, corporate officer, etc.) of s~id 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 thru' the work will be performed in the manner set fodh in the application filed therewith. .... ............ ....... ............................ __~~~ //" , (Signature of Iopplicont) ~ ~, ~o, 5~.~52~326 Suffolk County