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HomeMy WebLinkAbout1095-zFO,I~M NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located a~ .l~,,-..Rcl,.,...~aclise..Sllo~e9 ..... Street Soul, hold ~Map No,.~. ................ Block No .......~ ...... Lot Na,~ ....................................................................... :-. conforms substantially to the Application for Building Permit heretofore filed in this office dated .f~.~...~.....2..~ .......................... '., 19~?.... pursuant to ~vhich Building Permit No ....... .~.....~...~.. ....... dated .......... ~...~](....2..~ ................. 19.~.., ~vas issued, and conforms to all of the requirements of the applica~ble provisions of the law. The occupancy for which this certificate is issued is ..................... ,.*.~R~ATI~" ~[1~ "F~'~Y" S/Jl~gR'' 'i~IDENCE .......................................................... This certifxca~.e is issued to ............ .~.~.,.&.igli~J~t~h..~lc~la~2h~.,...nwner. ...................... , (owner, lessee or tenant) of the aforesaid building. A~0 Permit #Z109~, ,Tuue2, 1960 Building Inspector / FOl~f NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEI~T ON THE PREMISES UNTIL FU~LL' COMPLETION OF, THE WORK AUTHORIZED) ~TO Z Permission is hereby granted to: ~e~..;..~C~...~ ...................... :..:....:...: ......... pursuant to application dated ............ ~ ~ · · F~e $...~OO ........... FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined......~. ~J 19 ~'7 Approved.......V.. .............................. ] 9..,~,,.,'7. Permit N 2 Application No....~.....~...~. ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote ..................... 19 ~' ~/ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the BgiJding Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o 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 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 and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eiectrican, plumber or builder. ...................... ................................................................................................................................... Name of owner of premises...~..~..(~..~.~.,.../J.~..~..~...~./.~ .~./~...y.....~......~....~.../..~.....~...~2-- ~ ~.~ ~ ~"'"" "'~'~'"' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which pro. posed wo~k will be done. Map No ................................... B ack ./.~?t ................... Street and Number .~..(~.~/./~..~ ..-~...~../~.~ : ~.,.~. ~C[l.~..~...~...~....~...~.~..~.,,..~d.~..~...~.p../~.~ ~~. 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ . u ~ b. Intended use and ~c pancy ............................................ 3. Natu're of work (check which applicable): New Building Addition .................... · ................... Alteration. ............... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............... ~ .................................. Fee ............ ................... FEES: ,5. If dwelling, number of dwelling units ............ ./. .............. Number of dwelling units on each floor ...... I. ............... If garage, number of cars ................................... ]~fl/..e, ..................................... 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ........... ..~.c~...~ ............ 7. Dimensions of existing structures, if any: Front.. ~.~/' 1 ......................... Rear ...... .;~...~ ................ Depth ....~.......~T..~.../. Height ...../....;It.../. .............. Number of Stories ...... : ........ ..O..6).~. ..................... , ....................... ', ........ Dimensions of same structure with alterations or additions: Front ..... ,~.~.. ..................... Rear ....~..~.~ ...................... Depth ...... ,/~.../. ............... Height .......... .J~.../. .......... Number of Stories ........ I ....................... 8. Dimensions of entire new construction: Front ......... ?..?'.. ............ Rear ....... ...~..~.. ............. Depth ............................ Height ...... /~.. ................ Number of Stories ..... / ..................... 9. Size of lot: Front .....~.~.~.~. ....... ;.... Rear 1 8~# Depth ./~.?~.~J~..../~ -~'~ ~ 10. Zone or use district in which premises are situated ............................................ 11. Does proposed constructicm violate any zoning law, ordinance or regupton? ........ ~..~ ................................ 12. Name of Owner of premises..~'.~/~'....~..~...~.x~4~J'#/Address .Z'.~.~../.~...-.~.¢~44'1~/~..~.~one NO ..................... Name of Architect ...................................................... Address ....................................... .....Phone NO ..................... Name of Contractor ..............~.~.~.L.~.. ......................... 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 numbers or description according to deed, and show street names and indicate STA'~E OF NE'~ YORK, _ ) ~ ........ ! ~ O-'~ ............ ~ .... _~ ~. cou r 'S S., ' I ~-~~-~- ~. j~o ' ..~ t~ame ot ina~vlaual s~gning oppi~on) ~bov~ nomed. He is the ............................................ . (Controctor, ~gent, cor~rote officer, etc.) of sold owner or owners, ond is duly authorized to perform or here performed the soid work ond to moke end file this opplicotion; thor ~11 stotements conteined in this opplic~tion ore true to the best of his knowledge end belief; ~nd thor the work will be performed in the monner set forth in the opplicotion ¢iled therewith. Sworn to before me this .... ~.~- ..3 .......... day of ..... ~..~(,.~;~. ........... 19...~..q i~... (S~hg~t~J[e of applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Exam,ned ......... ~ ................. lcd.' c3 Approved .......................... .......... ,9..6. .Permit No. ....... Disapproved a/c .......I~'""i~'"~'" ............. (Building Inspectdr) APPLICATION FOR BUILDING PERMIT Date ..................... ..~..~........~......... 19..~.....O. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 location. 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 shaft be kept on the premises available for inspection throughout the progress of 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 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 and regulations. ......... i~i~'~;ture of applicant, or name, i a co po at'on) .... ....... ........ (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, Name of owner of premises.~.z...',"" ............ ..~.........e=......~ ....................................................................... If applicant is a corporate, if~ature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done_. Map No: ..~..~..%~..~ Lot I~o: .X....?... ........... Street and Number ....~'./...'.~....~~...~.........~.-..~ ......... ~'......~'"'~" ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use ond occuponcy ....................................................................................................... b. Intended use and occupancy .................. '.~ ................ ..~..../........~....~...~.: ......................................................... 3. Nature of work (check which applicable): New Building .................... Addition ......~.. ........... Alteration .................... Repair .............. ~r..RemovaJ .................... Demolition .................... Other Work (Describe) .................... 5'oo 5" 4. Est'mated Cost ............................................ Fee i~'~ I~'~**l~'~'id on filing t~is ~'l~'l~'li~i~i .............. 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.~'. ~ 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 ........... L ............... Rear ......................Depth ............................ Height ............................ Number of Stories ....~ ......... 9. Size of lot: Front ..... L..~...?. ............. Rear .......... t..~..~ .......... Depth .../..~.....~. ............... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are stunted ,~: ........................................ 12. Does proposed construction v o ate any zon ng ]aw, ordnance or regu at on? ........... ~. ................................ of Owner of premisesl~w'm.....L~...~...~f~..Addresst'X/¥~ '"~'#~' ............................................ Phone NO ..................... 13. Name Name of Arch tect ............ 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 numbers or description according to deed, and show street names and indicate wh_ether interior or corner lot. ['~o ;~ b STATE OF NEWc-~OP~K~ , $ ) S S COUNTY OF .... .;~'$~t.'L... ) ................................... ?.~/..~....~[..~....tr...~.l..~....being duly sworn, deposes and says that he is the applicant (Name of indivi~al signing applicatio~ above named. He is the .......................................... ~...z.m..%:- ............ ~ ................................................................................... (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 ~st of his knowledge and belief; and that the work will be performed in the ~nner set forth in the application filed therewith. Sworn to before me this ..................... '~ay of ......... ,..~..~... 19..~..~... 1~ t, ~, ~orJSi~ture of app~nt) ~ota~ public, StateulJoJk County FORM NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...................................... , 19 ........ Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c ............................................................................................ Application No ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ....... .......... .C.o. ................. ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o 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 progress of the work. e. No building shall be occupied or used in whole or in pa rt 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 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 and regulations. ~ue of applicant, or name, if o corporation) ...... ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises ..................... .j..~.O.,~.~4~...~..~."F~f~ ........................................................................... Name of If applicant is a corporate, signature of /a~uly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ..... .~..~*l-:m~.....~..../~..Ol.: ............ i...~ ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..~...'~.... 4. Estimated Cost ........ ~ ..~..~.~5.~. ~.~ ..................... 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 ..................... ~.~ ................. Z...~...~,~ ............................................................. 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 same structure with alterations or additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ...~ .......... ~ .........................· 8. Dimensions of entire new construction: Front ....... ~..~. ........ Rear ...~..~ ............ D~th ..~ ..................... Height ..... .~ ................... Number of Stories .................................. ~ 9. Size of lot: Front ........ L.~..~ ............. Rear ..... J.~ ............... Depth ..... J~.~ .......................... 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. Nome of Owner of prem,ses .~.. .Address ~. .1~.~ Phone N~ .... ~. ~..l:~.. Nome 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-b~ck dimensions from property lines. Give street and blockt numbers or description'~gccording to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) ~, - '~ ;~ ~ [~ COUNTY OF ............................ ) ~'~' .................. 2~_,~',.; .... ;:...%....., ................ beng duly sworn, deposes and soys that he is the applicant · ~ame or inalvlaual signing app iCQTiOn) above named. He is the ..... ~ ........................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty 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 to before me this ............ J~. ...... day of ...... '" "~ ............................, 19..~.3Z' ~ (~ Notary Public, . ........................................................... County b/(~ignature of applicant) FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ 19 ........ Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c .............................................................................................. Applica;tion No ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship t6 adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this location. 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 progress of 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 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. · .. ............... ........................ U (S'g o app icant,-'~'name, if a corporation) .... ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises .................. ~.O.i,,¢~....~...~..~ ..................................................................................... Name of U If applicant is a corporate, signature o'f duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number ...~..~....~ ....... /~G~ ............. .~..~ .................... ~...~ .................... Municipality 2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..~.. I" 4. Est im o t ed Cos t.....~..~_ ..'7....-~.¢.~..~. ........................Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................ cars .~ ~ /. ~_ ~ If garage, number of 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 same structure with alterations or additions: Front ................................ Rear ........ Depth .............................. Height .............................. Numl:ler of Stories ...... 8. Dimensions of entire new construction: Front......4~l~...Jl ....... Rear ..... J../! ........ Depth ..~..~ ..................... Height ....... ~. ................. Number of Stories ......... ~ .................. 9. Size of lot: Front ..... /~..O;~. ............Rear ...J,.~t'z~.. ............. Depth ....L.~,.'~. .............. 10. Date of Purchase ...~-~..~..'~ ....... 1..~..87~. ................ Name of Former Owner ..~l-~m~.....~...."~.i/~n,. ......... 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? .............. ~ ............................. 13. Name of Owner of premises...A.~*,,~rn..~?..~ddress/~,~.~.~¢...~.~.....Phone Name of Architect ............ ,......~. .................................. Address ............................................ Phone NO ..................... Name of Contractor .................................... .~.....~. ...... Address ............................................ Phone NO ~T DIAGRAM -\ locate clearly and distinctly all buildings whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block n_~_be~s~5~ de~'ql'~tion according to'deed and show street names and indicate whether interior or corner lot. '~-.-'~,~,¥" ~ STATE OF NEW YORK, ) COUNTY OF ............................ ) ................ ...................... being duly swarn, deposes and says that he is the applicant (l~l~me of individual signing app~'~'ti~ation) above named. He is the ............................................................................................................................................................ (Contractor, agent, corl~orote officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work end 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 to before me this ............... ,.o.... o, ..... ..................... j Nota~ Public, . ........................................................... County ~ ~ FORM NO. 1 Examined....! ....... ~. .......... l~...~... Approved ....... : ................... ..~ .......... 19..0....Permit No ............................ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT Date ~)_~4~,.~- ~ ~0 ...................... ~_.T .......................... ! 9 ............ INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and su~)mitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is port of this location. c. The work coYered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc.e 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 and regulations. ....... ........ ............................. (Signature of applicant, or name, if a corporation) (Address of applicant) State wheth,er applicant is owner, lessee, agent, archi~eect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... *".~.:~:: ................................. ;...; ...... .~. ..................................................................... If applicant is o corporate, s gl~ture of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .. .3.~.-......... Lot No: ..X.....~.. ........... Street and Number ..~Z.'~.. 0~r~/~o:~c~--,~.. ~ d~c,,~ -'-'~.J ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: occu ant, a. Existing use and p y ................................... ,~ ................................................................................................ b. Intended use and occupancy .................. :.: ................ ..,~.,Z....r~:~,..,,~..,.~,~.: ......................................................... ¥ 3. Nature of work (check which applicable): New Building .................... Addition .....'.~ ........... Alteration .................... Repair ............... ~,...RemovaJ .................... Demolition ................ Other Work (Describe) ............ · o --- 5- 4. Eshmoted 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. ~f business, commercial or mixed occupancy, spec fy nature and extent of each type of use....,....~ ........... ......... 7. Dimensions of existing structures, Jf any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ / /o ox? 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 9~Former Owner ........................................................ 11. Zone or use district in which premises are situated ......................................................... /~;~ ............................... 12. Does proposed construction v~R, late an}~,zon~ng~l~w, ordinance or regulation? .................................................... · ~ {/vl ~ ~'~ 13. Name of Owner of prem~ses..(~:. ....................... ;;.~....~.. 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~'.ORjKI !~ ) SS COUNT OF ..... ' ............................. ~....~.....[ ........ ...~:...~..'~.....~X.....belng du~y sworn, deposes and says that he is the applicant above nam(eNc~ml~e °Jsf tJ~ed~I.-.s;i~.~.i.~..~l.l.~i.I;~.~. ........ ;~" ........................................................................................ (Contractor, agent, corlborate 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 oil 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 to before me this ..................... ...'~day of ........... i~ ...... 19 ...~es,/~u~stT~'teB~°fl(~ew uY~S gnat,ire of applicant)