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Home My WebLink About9197-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUYHOLD, N.. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereb~ granted to: ~? ~: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am ned ........... .7.. ............... ......... Disapproved a/c ........................... ~_~...0_.._.,...,.---------- ....................... APPLICATION FOR BUILDING PER~IT / INSTRUCTIONS o. Th~s application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Buildin Inspector, with 3 sets of pl<~ns, accurate plot plan to scale. Fee according to schedule. b Plot plan showing Iocotior~ of lot and of buildings on premises, relotionshfp to odjo,mng premises or public streets, areas, and giving o detailed description of layout of property must be drown on the diagram which is port of th~s opplicotior c. The work covered by this application may not be commenced before ~ssuonce of Building Permit. d. Upon approval of this application, the Building Inspector wdl issue o Budding Permit to the opphcont. Such perm 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 whoteyer until o Certificate of Occuponc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe. The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors or~ 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 ............... ................................................ . ............................................................................................................... // Pebble lc alt · Inc, Name of owne/~ prem~7 ............... 'y !~'"~' ...................................................................................................... If applicant !~ corpor~/~, ~)~h~turyAf , ~l)/~/6uthorized officer. ~)(' ............/~' ~' "~' '~ fl I ce r) ' ........ ~ ............... Donald M. Fversoll· Presldent" Builder's License No ................ ~ ~.:~... ........... Plumber's License No ................................................. Electrician's License No ............................................. Location of land on whic_b_pr~oposed work will be done Map No ........ Lot No ......45 d :l Street and Number .... ...~.~.~........b~....~ ............. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exfsitmg use and occupancy ......... ..V.g.~.q.n..f..[q.0.~l ........................................................................................... b Intended use and occupancy ..M,.o~.! home ~...~.~. C~, L ~ ~~ 3. Nature of work (check which applicable). New Building ............ Addition ................. Alteration .............. Repair ................Removal .............. Demoht~or. ................. Other Work .... .F..e..n..c. !.n. ~1 ................................. (Description) 4. Estimated Cost .........A.P.R.r.°..x..:....$..5..0..0. .......................... Fee ................. ~. !. .5. ... .0. .0. ........................................................... (to be pard on filing this application) 5 If d~elling, ,number of dwelhng umts ....................... Number of dwelhng un,ts on each floor ......................... If garage, number of cars ...................................... >. ................................................................................................. 6 If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7 D~mens,ons of ex~stmg structures, if any' Front ........................... Rear ................................ Depth .................... Hmght ...................... Number of Stones ............................................................................................................... Dmnens~ons of same structure with oltel~at~ons or adder,ohs Front ....................................Rear ....................... Depth ............................... Height .......................... Number of Stories ................................ 8 Dimensions of entire new construction' Front .................................. Rear ............................ Depth ...................... Height .................Number of Stones ................................................................................................................. 9 S~ze of lot Front .................................................... Rear ........................................ Depth ............................... 10. Date of Purchase ...................................................... Name of Former Owner ....................................................... 11 Zone or use distr,ct ,n wh,ch prem,ses are s~tuated .............................................................................................. 12 Does proposed construction violate any zoning law, ord,nance or regulation: ............ ..N..o. ...................................... 13 W~II lot be regraded ............................ Will excess f,II be removed fram 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 d~stmctly all buildings, whether ex~sting or proposed, and ,ndicate all set-back dimensions fron property hnes G~ve street and block number or description according to deed, and show street names and indicat. whether interior or corner Iol See Attached Survey S]-ATE OF NEW,,Y, JD~I~,,/ t S COUNTY OF ....~ur.r..~..~..~. ............. f S ....... .D.o..n..a.!..d...M........E.y..e.r.s.o..J.! ................................................ be,ng duly sworn, deposes and says that he ,s the apphcar (Name of ind~wdual s~gnmg contracf) above named He ,s the ........... .B..u.j]..d.e..r..-....?.r..e..s]..d..e..n.t ......................................................................................................................... (Contractor, agent, corporate officer, etc),~ of sa,d owner or owners, and ~s duly authorized to perform or have perform~]/the sa~d work and to make and f,I th~s application, that all statements contained m this apphcat~on are true tg/t~e best of his knob, ledge/and behef; an that the work w~ll be performed in the manner set forth in the apphcat~on filj/'d/therewit~ ./~ Sworn to before me th,s ........ ]..8.th. ......... day of ....... A. pr[.I ...................... ,19 ~ ,ota Pub,,c, ' ............... ............... THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM RELD OBSERVATIONS AND/OR FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES APPLICANT ADDRESS-- -- - ---- TEL Lot 46 vACAN~' spoce UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE W~W YORK STATE EDUCATION LAW COPIES OF THIS SORVEY MAP NOT BEAR[Ng THE LAND SURVEYOR'S INKED SEAL OR Lot 45 = E7819 sq'ft NOTE · = NIONUMENT SUBDIVISION NMP F/LED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JUNE II~ 1975 AS FILE NO 6266 REVISIONS MAR $ ~1977 A?g '7 /977 YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: PEBBLE BEACH REALTY, INC. LOT 45 "PEBBLE BEACH FARMS" AT EAST MAR ION 'row. OF SOUTHOLD SUFFOLK CO., N.Y. SCALE. II''= 40' J DATE: JGUARANTEED TO: OCT. 27, 1976 j NO. 7~.940e