HomeMy WebLinkAbout9047-z FORM NO. 2
TOWN OF SOUTHOLO
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
t� 9®4 Z Date ...........................Fab........18'.......... 19...�7
Permission is hereby granted to:
: ....................: .. ....................
.....................390.....AbLS SO-St..........#34u.: bold
to ..tini�.c)...now .aCuc� ;.yoa^,Y.. :ua`afi ` ...i,��:LC111a ..............................................................•..
.........
atpremises located at ...Web S 9�......�.............................................................................I..................
.................................................6outhrairl.......X..Y...........................................................I.................
ppursuant to application dated Feb 9$ 19 7?. and approved by the
PP .......................................... ........... .. ...... ,
Building Inspector.
Fee $.....10.00....... '
t;1„ /1 ........
Building nspector
® X --sh no ton fr
Perm
1~0~ NO,
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
Examined ........~ ........ ~. ................... , 19- .
........................................ , 19 ...... ;. Permit No .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
o. 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 a~Jjoining premises or public streets or
areas, end giving a detailed description of layout ofproperty 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 ssue 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 hove 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.
(Signature of applicant, or name, if a corporation)
........ .......................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner o p emmes ..................................... ...................... ~ ............. t, ...................................................................
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 ...............................................
1. Location of land on which proposed work will be done. Mop No.: ........................................ Lot No ...... ~..~. ...........
Street and Number ..... ~.~...~........~.....~...'~..~..:-z..~...C~........~....'~.. ..................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy .......... .L.~....Q..~..\.~ ..................................................................................................
b. Intended use and occupancy ........... ..~....0..O..~.......~;...~.~....L~.. .............................................................................
Repair .................. Removal .................. Demolition .................... Other Work ....................................................
~ D a U ,¢4.) / '~' FJ-o (Description)
.; Estimated Cost .............. ......... ~J .................................... Fee ..r........' ...............................................................................
(to be paid on filing this application)
5. If dweJiiog, 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 ....................
Fleight ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
Dimensions of entire new construction: Front ........... ~ ........ . ............... Rear ........ t...°. ............... Depth ...... 7...i ............
Height ........ z .......... Number of Stories ....................................................................................................................
9. Size of lot: Fronl ........................................................ Rear .......................................... Depth ................................
10. Dote of Purchase ........................................................ NomeAof Former Owner ........................................................
11. Zone or use district in which premises ore situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ...l~....q ........................................
13. Will lot be regroded ....... .~....~. ............. Will excess fill be removed from premises: ( ) Yes ( ) No
14. Nome of Owner of premises .~.?.!?..~..i~......!.~..t...d...~.k...c~...l ...... Address'5..~.'~....~..'..~.~...~/~r~.~.OPhone
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor ............................................................ Address ................................ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate ail set-back dimensions from
propcrty lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or
orner Jot.
~ ~_ CT<---[__
STATE OF N~ )'~Rl(,, i IS S
COUNTY O,K~/*,~,~'. .............. f '
.............. .~.~.. ~...i..~...'....1~7... ! .g..~'~...~....u~...[ ............................... being
(Name of individual signing contract0
above named.
duly sworn, deposes and soys that he is the oppHcam
He is the ................................. ~...u~.,...~....~-.......~m'. ......................................................................................................................
{Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove 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
thor the work will be performed in the manner set forth in the application filed therewith.
Sworn ~pl~,/~e.-~z~, me~hi~~ 19 ~Z
........ ....... ........... .,....., ....... , .
No. cou. ................... .............
of
FORK NO. 1
f TOWN OF SOUTHOLD �!
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
� l
Examined ....... .... .......... .......... .. 19...f q Application No. ..................J........... .,�
Approved .............. ....... ...... ., 19.77 Permit No. .C!..G�. ..,Z .. Z
R
Disapproveda/c .... . ... ...... .............
.......................................................... ....... �.
........................ ::. .................................... .. .........................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date .F r.r3.�' 2 .....0. ........... 19.-! ......
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 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. 1
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 Department for the issuance of a Building Permit pursuant to -the I
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. 0(
............ :. -` .:. �.. ............ .......
(Signature of applicant, or name, if a corporation)
'310 03 'N.� iNssc, � ,
...... .... ... ......... ..�.................
........... ..... ..... .... .
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...................................................................................................................................................................................................
Nameof owner of premises .... ....... ....................................................................................
If applicant is a corporate, signature of duly authorized officer.
..:.....................................................................................
(Name and title of corporote officer)
Builder's License No.
Plumber's License No. ....................:........................... `
Electrician's License No. ............................................
Other Trade's License No. ..............................................
1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No: ......
.��.. .............
Street and Number .............�. .4�...�X.l. .14.5..'�.�?........ .........................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy .........h.JQ M.E.............................................................................. ..........................
b. Intended use and occupancy .:........:r.a.QA .....:,'. 1.7�... .:.............................................................................
i
r
3. Nature of work (check which applicable): New Building. ...... ... Addition .................. Alteration .................,
Repair Removal .................. Demolition.................... Other Work ................................................ .....
z-� (Description)
A�. Estimated Cost .........P..Q...C?.,J).... .............................Fee ....I...................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ............................
Ifgarage, 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 some structure with alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................Number of Stories ............... ..............
$. Dimensions of entire new construction: Front ............�..f2.`.................. Rear ........
A .0................ Depth ........ ................
Height .......(0-1........ Number of Stories ........A........................................:....................................................................
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 ...............A...................................................................................
12. Does proposed construction violate any zoning law, ordinance . or regulation: ........................................................
13. Will lot be regraded. .......UP............ Will excess fill be removed from premises: ( ) Yes ( ) No
14. Name of Owner of premises`�� ..(�.:.. 1. �.iT .1-.1....... Address ....'
Name of Architect .............................................................. Address .......:........................ •Phoney 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.
z F
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i
I
l a7 -yam y I�o
i3c,oe
Di=
STATE OF N YF4 .
COUNTY , . ... ................jS.S
....f . ?.......: 1. 3.Ir.Lr.., being duly sworn, deposes and says that he is the applicant
!. �1 — a. ..............
(Name of individual signing contract)
above named.
He is the �� ta' ....................................................
:......................................................................
..................................................
(Contractor, agent, corporate officer, etc.)
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 t bef�me t 's
fEl
............ .. d_ of ..... ::..........I 19.17 � c�
�--. may'
Notary Public, .. . .. ��.. . County ............ .. .............................. ..............................................
ARTHUR. E. GE1GCN (Signature of applicant)
PU%I�I�`8`ptla c.State.•d!tie.4 Yo4ik
No.52-1356200—Suf oils WAY
-4ommission Expires March 30, 1977!�
� ���SSPooi �•w�//
formerly
Cedric H Wickham
O
137.98�
N.84°2l 00 E.
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26.4' \
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IN 2
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--�_ 5.84°21�00„� O
+ u.;. 45�.� ? !/tea¢n f•._ O
Q (^ Cb
vyJ can f ormerly
o Cedric H. .WickhGm
y SUFFOLK .COUNTY HEALTH DEPARTMENT
JUN 0 7 1976 S le5l fio/a
DATE H. D. REF. #
Cal 0.o
•AThe sewage disposal and water supply
facilities for this location have been
opinspected by this department and found �y
,to be satisfactory.
• ChiW- - enera Engineering
N / /f e -- - --56
Or/IO/ /S san�
ROAD ,Z.o
THE LOCUTION OF WELLS AND CESSPOOLS SgPjE OF NFfy
NOTE SHOWN HEREIN ARE FROM FIELD OBSERVATIONS
■ =MONUA9ENT
IiNDIOR FROM DATA OBTAINED FROM OTHERS o�PEtD h! O�
r.
0
REVISIONS
YOUNG & YOU
APRIL9,1976 400 OSTRANDER AVENUE, RIVERHE D, EW .47'{Z{�!
ALDEN W. YOUNG l WQ,RD W,,YO G
PROFESSIONAL ENGINEER AND
LAND SURVEYOR. N.Y.S. LIC. NO. 12845
SURVEY FOR:
THISSUNAUTHORIZED
ALTERATION OR ADDITION TO JOHN R. F/NELL/ 8 LILLIAN F/NELL/
THIS SURVEY IS A VIOLATION OF SECTION
7209 OF THE NEW YORK STATE EDUCATION
LAW '
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYORS INKED SEAL DR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY , AT GUARANTEED TO:
LAUGHING WATER USL/FE TITLE INSURANCE COMPANY
GUARANTEES INDICATED HEREON SHALL RUN OF NEW YORK
ONLY TO THE PERSON FOR WHOM THE TOWN OF
SURVEY IS PREPARED,AND ON HIS BEHALF SOUTNOLD R/VERHEAO SAVINGS BANK
TO THE TITLE COMPANY,GOVERNMENTAL ✓OHN R B LILLIAN F/NELLI
AGENCY AND LENDING INSTITUTION LISTED BY
HEREON,AND TO THE ASSIGNEES OF THE SUFFOLK CO., N.Y.
LENDING INSTITUTION. GUARANTEES ARE
NOT TRANSFERABLE TO ADDITIONAL SCALE: ii DATE: NO.
INSTITUTIONS OR SUBSEQUENT OWNERS. / = 40 DEC. /, 1975 I. 75 -85
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