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Home My WebLink About13191-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cerfificafe Of Occupancy · June 5 No. Z..1 ~.5. Q8. .......... Date ................................. 19 84 THIS CERTIFIES that tile building . 0 ~'~'.i, q V ........................................ Location of Property ...2,79~.q .~.i.~. I~oad .... Cui;chogue House No. Street H,~let County Tax Map No. 1000 Section J .0.2. ........ Block 6 . .Lot .7. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofoire filed in this office dated ·.. YI~.y..1.7. ........... 19 .~t~ pursuant to which Building ?em~it No. '133.9.1.¢ .............. dated ....... ,l~ma. 5 .............. 19 .aq, was issued, and conforms to all of the requirements of th~ applicable provisions of the law. The occupancy for which this certificate is i~sued is ......... .... F.. o r..~.n~ I;~.]J. al;;Le.n. ~..a. BJ-.l.q o. ~.a,,~ ~¢.o.r~ t~. il.o.qU ........................... The certificate is issued to 4q5¢ ~a.v. y C..p. 9p of the aforesaid building. Suffolk County Department of Health Approval ........... Jq./.~t ........................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 ]FOB, lr~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13191 Z Count, To× ~o~ No. ,ooo Se~,on ..... -,.=....-=.. ..... B,ock .......... .~. ....... Lot No ......................... Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ......... ~.....~ ....... , 19.~..~.. Permit No....~.~.~.~ ....... . ..... O~sapproved a/c ............................................................................................ (Building Inspector) Application No ................................. APPLICATION FOR BUILDING PERMIT Date May 17 19 84 INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 ofproperty must be drawn on the diagram which is port 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 budding 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 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 Lows, 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 applicant, or name, if a corporation) /~OAN M. CRON ~ I . New Suffolk Ave, New Suffolk, NY 11956 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Nome of owner of premises JOAN MARY CRON If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... ~/.A ...................................... Plumber's License No. ..~/.~ ...................................... Electrician's License No .... ..~../.~ ................................. M/A Other Trade's License No ............................................... Ta 1. Location of land on which proposed work will be done.~Map No.: ..].D2=.f.=2 ...................... ~tX[KI~ ......................... Street ond Number . .(D.,O....~.).....M.a,.in. Road, Cut.c.~ogue~ New York Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ .Q~...f.~'g.,e....~.~.i..~_.~.i..~g ................ ' .......... b. Intended use and occupancy Same 3. Nature of work (cbeck whicb iopp}icabk.) hk',v bni!d~'ng Addition Alteration .......... ". · Repair .................. Removal J .................. Demolitior ..................... Other Work Iastall .a,~i. oa..,.. .................. . ........... of .,.......basemeat~'..., · ,: door (BI~cDdr~cripti°n) 4. Estimated Cost $ 500.00 830.00 ................ ' k ................... Fee ......................................................................... I (to be paid on filing th!s application) 5. If dwelling, number of dwelling units ..... .,~./.~ ...... : ........ Number of dwelling units on each floor ....... ~../..~. .............. If garage, number of cars N/A 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .b,.u...s.~..~..e..s...s. ......... 7. Dimensions of existing structudes, if any: Front ...... 3..7..'. ................ Rear ....... ~.,5..'. .................. Depth ...... $.~..'. ........ Height .....3..0...'.._+. ........... Numb!er of Stories ..... ~ ................................................................................... : .................... Dimensions of same structurej with alterations or additions: Front same Rear same Depth ................................Height ......... .s.,.a.,m,,¢. ......... Number of Stories ......... .s..a...m..e. .............. i 5½' , Rear ........ ,~. ................. Depth ..... 2..~ .............. 8. Dimensions of entire new construction: Front ................................... 5 ~ I N/A Height .................... NumberI of Stories = '+ i 100'-+ 9. Size of lot: Front ...P.0. ......... i ...................................... Rear ......... §.O..'..-+.' ........................ Depth ................................ 10. Date of Purchase . ,ff.u~,'e~ 1967 .Name of Former Owner ...... .~..$.q~AC~.$...~.O.D.~1, ..................... ~ 1. Zone or use district in which premises are situated ....... .C..Q .fg~....e...r.g..$.,a.~ ...................................................................... 12. Does proposed'construction viglate any zoning law, ordinance or regulation: ........ .~...o. ........................................... 13. Will lot be regraded ..... ~.o. .................. Will excess fill be removed from premises: ~ ) Yes (×) No ' New Suffol~ Ave. Name of Architect ........... /.~ .............................................. Address ..ur.,. ...... ~ ........ .,. ....... Phone No ....................... Edward Brush Stz--water Ave. J'qome of Contractor .................................................... Address ,Cu.tcb.og.ue.,...Jg.Y Phone No. PLOT DIAGRAM Locate clearly and distinctly al buildings, whether existing or proposed, and indicate all set-back dimensions from ~roperty I nas. Give street and Nock number or description according to deed, and show street names and ndlcate vhether interior or corner lot. ' i SEE ANNEXED SURI~EY AND DIAGRAM 'TATE OF NEW YORK. .................................. .~..O...~..~....~.:....C..~.O.~ ................................ being duly sworn, deposes and says that he is the applicam (Name of individual sig¢ing contract) .:hove named. O ~ (Contractor, agent, corporate officer, etc.) S~}{~X~C-r:Y-4YCf~;~, and is du!y authorized to perform or have performed the said work and to make and file ibis application; that all stetement~ 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. Swam to before me this i Notary Public, , .~.uf.~.o.l.k. ..... County .................... ~ ............................. .............. "" ............ ' ............ , ~/ (Signature of applicant) Not J'ry ' Notary I)ubfle. State of New York " i N0.4739255- Suffolk County g ,. ¢o.llalsslon Expires March 30, 19 ~ ,5