HomeMy WebLinkAbout1365-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BERTIFIP. ATE QF rqP. 13UPANBY
THIS CERTIFIES that the building located at .8/.l~. p.v~, .Rp.0.:W: ........... Street
~.p ~o. ~.~,~ ..... Bloo~ No. ~ ....... Lo~ ~o. ~... ~)~. ~ ........
conforms substantially to the ~pplicat[on for Building Permit heretofore filed in this office
dated . .~8~.~..21~..1961 &
... , 19 .... Dursuan/to which Buildiug
dated .... ~a~. 21~. 1~61 ..... , 19 .... , was issued, and conforms to all of the require-
ments o~ the applicable provisions of the la~. The occupancy for which this certificate is
issued is . .~r!~a%~. 9~. f.a~$1I .4~ll~n~
The certificate is issued to H~!~..~.~.... ~ ................................
(owner, ~essee or tenani)
of the aforesaid building.
N~, at that time
Su~olk County Department o~ Health App~ova~
Building Inspector
FOP,,M NO. 2
TOWN O~: SOLITHOLD
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)
N.° 1365 z
Date .................... /~.~i~ .......... 21. ........... 19-61.
Permission is hereby granted to:
-...H~%m~t.....H~s~ ...............................................
..................... Gree~porC~-~......N.~-Y.~ .....................
to ... 'Bt~ti~" new.. one" 'f ami.~y...~wei.~t~ .................................. ; ...............................................
at premises located at ... / ..... ~'"RO'ad ........................................................................................
.................................................................. Sea. the.l 6 ~...N, .~.~ .............................................................
pursuant to application dated ................................ ~l~t~...-~. .......... 19(~!..., and approved by the
Building Inspector
F6e
Building Inspector\
COUNTY OF SUFFOLK
DEPARTMENT OF PUBLIC WORKS
H. F. BISHOP, COMMISSIONER
YAPHANK, N£W YORK
March 28, 1961
Town of Southold
Office of Building Inspector
Southold, New York
Att: Howard Terry
Re: Helmut Hass
North Road, Southold~ NY
Dear Sir:
W~ are returning herewith your four
copies of Building Permit applications filed by
Relmut Hass. We are enclosing a s~auple copy of form
to be used for permit under 239K of the General Municipal
Law, to be sent to us in triplicate. Attached to forms, include
three copies of survey showing location of proposed con-
struction.
We also direct your attention to the fact
that where access is necessary to the County Highway, adjacent
to the pre~_ses of the permit, it is necessary for the appli~
cant to secure an access permit under Sec° 136 of the Highway
Law. In order to accomplish this purpose, the applicant
will submit to this office four copies of his sketch or map
showing buildings and location of, proposed access,
May we point out to you that applicat%on
for the 239K is made by the Building Inspector's Office,
whereas the application for permit under Sec. 156 of the High-
way Law is made by the owner directly to the Suffolk County
Depto of Public Works~
Very truly yours~
WSMjr:EWJS:ec
encl.
William S. Matsunaye,~r.[/
Chief Engineer
FOI~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
.~.' ~ SOUTHOLD, N. Y.
· t
............................ I ........... ,
~ ~ ~ ~ RENEWAL of
Approved ......................................... 19 ........ Permit No .......1~6.~...~ ...........
Disapproved a/c , ~~
(Building Inspector)
APpLIGATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
[nspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, end giving a detailed description of layout of propertymust 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 approvai 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 i~or 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, building code and regulations.
(Signature of applicant, or name, if a corporation)
............. N.m:.~..l~oad., ........ S~.u.~hold ...............................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
............................................ Dwn.er.../~z~i l~e~. ......................................................................................................................
Name of owner of premises Helmt~t Hass
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer}
1. Location of land on which proposed work will be done. Map No: ...... ;7-~;~ ............................ Lot No: ~ ............
Street and Number ..... ~/S'.....~or.J;;h..~aa~l~...~o~.tJ~o3,cl.r..~..~. ........................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .............. .~.a.e~a~t..&s~d ..........................................................................................
b. Intended use and occupancy ................. Oz~e...faz~J,l~...d.~e,%l&~§ .....................................................
3. Nature of work (check which applicable): New Building .~:Q[~ ...... Addition .................. Alteration ..................
P, epair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........... .q~l,~ .......... Number of dwelling units on each floor ............................
If garage, number of ears ...........................................................................................................................................
6. If business, commercial ar 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 ........ ~0. ..............Rear ........ ~.Q ...............Depth ..... ~..b¢. ..................
Height ............................ Number of Stories ....O~ .................
9. Size of lot: Front ...~.Q.O. ................. Rear ...........3..0.0 .........Depth ........... 3.2.~...P~ ......
]0. Date of Purchase ........................................................Nome of Former Owner ........ [~.....l~:J.C~Ll~OXtd .....................
11. Zone or use district in which premises are situated ......... ?.~.~.[..~-1~ .....................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~P. ..........................................
13. Name of Owner of premises ..~.~...~1.~ ..................... Address ........... ,~p,l,l.~o~.d ............. Phone No .....................
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-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 YORK, 1 S.S.
COUNTY OF ..S.u££o3,k .............
......................... ,~..e..~..~..~j~.~.~ ............................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ........... g'~zez:....-..,~g~l~a~ ..........................................................................................................
(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 apptication that all statements contained in this application ore 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, i
Sw°rn t° bef°~ ~ tho~.. J~ , 19 .,6 ~ ~ ~
y ............... ~ .......... ~,
NIotc n, Pub c ././.~~u~~ Cou~ ~ ~'" ...... (~ignatur~ applicant)
TE)WN SL3UTHE1LD
BFFIBE OF BUILDING INSPEBTBf~
TOWN CLERK'S BFFIBE
Mr. H.F.Bishop
Commissioner of Public Works
Suffolk County
Yaphank Ave., Yaphank, N. Y.
Dear Sir: CR 27
In accordance with Section 239K of the General Municipal Low of the
C,o. nsblidated La,ws of the State of New York, this is to notify the Commis-
sioner of Public Works of the County of Suffolk that ..... ~e].;Kl!,Lt...~as.s. ......
Ar shamomaque, Oreen~ort,
........ O.~1 ...a p.P.1 i~ ~.1; ~.o.n.. P:13.6.¢. .............................................................
has.applied to the Town of Southold for a permit to construct a building
on": ..~.~l.v...a..t..q....R.p..a.¢, .,... f./..S.'..C...q~..n..t.y..t.~..o..a...d 27.~., S otzthold , N.Y.
ltO,O ~ W/o l~everly }toad (private),
aS shown on the attached plot plan, submitted in triplicate, da,ted
We shall withhold further action on this application for ten days or as
otherwise provided in the aforementioned Section 2391(.
4/17/61 APPROVED pursuant to Sec. 2.39t~,
of the General Municipal Law. No permiVtery truly yours,
under Sec, 136 or the T '
. equzred as access will be fro~ a .
private road for proposod dwo],li~g~
SU[~0LK COUNTY DEPT PUBLIC WORKS
H. F. BZSH0i', Corm~lissiomer Howard %erry ~
. Building Inspector
,. ' Town of Southold, N. Y.
TOWN OF SOUTME)LD
DFFIIDE OF BUlL, DING INSPEE]TEIR
TOWN BLERK'S OFFIDE
SBUTHOLD, N. Y.
Mr. H, F, Bishop
Commissioner of Public Works
Suffolk County
Yephank Ave., Yaphank, N. Y.
Dear Sir:
In accordance with Section 239K of the General Municipal Law of the
consolidated Laws of the State of New York, this is to notify the Commis-
sioner of Public Works of the County of Suffolk that ..... H~m~.%..]CAS~ ......
..... A.r..,%.hft~ .o.~,t:l..p,~.~....G~ ~.c~.~.t... ~. ,. ~., ..............................................
....... .0~l~... app. t l.aa~i t~,~.. ~J,.3..6 % .............................................................
has applied to the Town of Southold for a permit to construct a building
on . ~.~1~. ~t e.. ~o.~,.,... S./S...C.Qu.~t~,..Ko.~rL.~'?k~...~.~t~h~.l~.,,...t~,
os shown on the attached plot plan, submitted in triplicate, da,ted ................
..~..~...~-O..]?...3.,.~.,...~.?..6...]:. ............ and titled ...?;~.:.O..~....?...]:.~..?...O.~...~,(:~.~..~.Z.~....~,'~..~$
We shall withhold further action on this application for ten days or as
otherwise provided in the aforementioned Section 239K.
Very truly yours,
How~r~ Te~y
Building Inspector
Town of Southold, N, Y.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y,
Exe m. ned...../.~.~..,,,~.,,~f.,....~J..t ........
Approved ........:~.q,c,~.¥. ..... ~.'..~. ....... 19.~,[...Permit No ...............................
~,~p ~oved ~/c..,.U..~..~,,~........p.?~,:. :,: ........ )..... ~:,,* ........... ~ .......... ; .....
App,,cet,on ..........
APPLICATION FOR BUILDING PERMIT
~ote ....... '.).~'.l~.,~.',.~ ...... '~,.~....: ............. ~9,b.t...
INSTRUCTIONS
o. 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 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 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 a Iterations, 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 o corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................. c~...,,...Bu$14~r. ...........................................................................................................................................
Nome of owner of premises .......... ~[el~ll.t,..'~&~ ................................................................................................................
If applicant is o corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No: ...... ~ .............................. Lot No: ...~[,~Ji~ .........
Street and Number ,.~/J~..J~'.~..~t.....L~'ll,t,,J~W.f~,.~., .........................................................................
Muniopality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...... ~..&~l~,l~.~.....~.~,~ .................................................................................................
b. Intended use and occupancy...C~D.~L~./~l~....~?l~l,~,~lg ................................................................................
3. Nature of work (check which applicable): New Building....~l~l~ .......... Addition .................... A~teratlon ....................
Repair .................... Removal .................... Demolition .................... Other Work (Describe)
4. Estimated Cost....~.)..~,.~.!];......./~.(.'.f. ......................... Fee ....... '10~..00 ......................................................................
(to be paid on f/ling this application)
,5. If dwellihg, 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 ......... .~0 .............. Rear ........... '~0 ............ Depth ........... ~ ............
Height ............................ Number of Stories ....¢~1~11~ ................
9. Size of lot: Front ......~00 .............. Rear ...,~00 ................. Depth .,.,~ .................
10. Date of Purchase ........................................................ Name of Former Owner ....... We...R~[~II[OI~ ......................
11. Zone or use district in which premises are situated ...... ..#~.~.,..~1~,~1~ ............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ...... 1~ ...........................
13, Name of Owner of premises.....~l,...l~ll, lllt ................. Address .....t~I~1~'.1~ ................. Phone NO .....................
#
Name of Architect ........................................................ Address ............................................ Phone NO .....................
#
............................... ............. Phone NO.
Name of Contractor .................................................... Address ....................
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 numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STA'TE OF NEV~,~Y~., ) S S.
COUNTY OF ..?...~.,.~..~...'~.. ......... )
.................................. ~ ~I~ ..................... being duly sworn, deposes and says that he is the appl~can~
(Name of individual signing application)
above named. He is the .................. ~...~..~ ....................................................'~ ..................................................
(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 a I statements contained in this application are true to the best of his knowledge and belief;
and that the work will be performed Jn the m~nner set forth in the application flied therewith.
Sworn t~.~ore zt~ifs ........ : ...... .~.t.~.~:(~;~~ f ~ ~ (Signature ~ a::licant)
Nota~ Public, ....:,.....~;..~ ........... .,..;:'.;.,,?..,,:: ........ County i,~~ ~;z~,~ ~.~ ]4.~
NO. I
TOWN OF SOUTHOLD
BU. ILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ............. ..~....%..".. ................ 19 ....
Approved ........................................ , ]9....]...Permlt No ...... i13.6%...~ ............
ion NO .............................
APPLICATION FoR:BuILDING PERMIT
Date ......... ~' ~
.............. .......7.. .......... , m...6.f. ....
INSTRUCT ONS
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 propertymust be drown 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 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 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 lows, ordinance~f building code and regulations.
(Signature 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.
..................................... .Ou:,.te~' BU~.&d ~,~. ............................................................................................
Helmu'~ Hass
Name of owner of premises .....................................................................................................................................................
If applicant is o corporate, signature of 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 ...... ,.m.,/.~ .. ~,Q~.~h...RO.~d.~...~.OD,~kOlr~I.~...N,.[,~ ............ i,; .................................................
Municipality
2. Store existing use ond occupancy of premises ond intended use and occupancy of proposed construction:
o. Existing use ond occupancy ............... ~.gO~...~a~ ........... ~ ...... ] .................... ':; ................................................
b. Intended use ond occuponcy .................. ~,..~]~1~...d~,..~$~ .................... ~ ............................................
3. Nature of work (check which applicable): New Building ..](.]~u,TJ~ ...... Addition .................. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
4. Estimated Cost ..........I~,/.~OO..P~ ........................... Fee ....... ~',OO .........................................................................
r- (to be paid on filing this application)
5. If dwelling, number of dwelling units ........... O1~11 .......... 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 ........ .~ .............. Rear ....... ;.]~) ............... Depth .....~ ..................
Height ............................ Number of Stories ....O1~1 .................
9. Size of lot: Front ...~,00 ................. Rear ............ 1.00 ......... Depth ............ ]~.~...l;I/ff. ......
10. Date of Purchase ...................................... .Name of Former Owner ......... 1~.....~t. tt~mont] .....................
11. Zone or use district in which premises are situated ...... i..ll~ll..~!,l,~t .....................................................................
12. Does proposed construction violate any zoning law~ ordinance or regulation? ....... I1~ ..........................................
13. Name of Owner of premises ..}[,...}J&~. .................. ,iAddress ........... ~tOlltg~a.8 ............. Phone No .....................
Nome of Architect ...................................................... Address ~ Phone No .....................
Name of Contractor ........................ .~.t ......................... Address ........................ II .................. 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. ~. : · . , ~. {~.~f;:~ jo.,
STATE OF NEW YORK, '[ S.S.
COUNTY OF .E]~.£eitl~ ............. J
......................... ~,l,l.t~..~.l~e.~ ............................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ........... 0.~e...,,,..i~.~CJ~l~ ..........................................................................................................
(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.
...................... ..... ....... .;; ....... ...........
FOEM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
E×amined ............. ...M~...~.Ch.....~3 ...... 19..6..~...~ene~al of
Approved ~ 19 ........ Permit No. 1.~,6.~'2; ....................
Disapproved a/c ........................................................................
C (Building Inspector)
Application No. 1.S~ ..................
.~PPLICATION FOR BUILDING PER,MIT
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 propertymust 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 approva[ of this application, the Building [nspector 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code and regulations.
(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.
........................... /3wner...,,...buil~le~'. ..................................................................................................................................
Name of owner of premises ...... Helmv, t,.Iiass ....................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
t. Location of land on which proposed work will be done. Map No: ......... ~ .................... Lot No:X.~'.-~. ...........
Street and Number ....~./.~...~.~J3...~.O.f~f~.~ ......... .~..q~.~;..h..o...~..d. ..................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...V. s43/h'3.t~..~a:r~:;1 .....................................................................................................
b. intended use and occupancy ........ DD~.../'~I.'l~..d.~iell&rt~ ..........................................................................
3. Noture of work (check which applicable): New Building ..... .:~[iX~,~ Addition .................. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
4, Estimated Cost ...,14.1.~'O~..J~/.JJ .................................. Fee ....... ~..,~QO,..~elc-e~.~. ................................................
(to be paid on filing this application)
5. if dwelling, number of dwelling units ....... ~e .............. Number of dwelling units on each floor ............................
.1~ ggrage, number of cars ...........................................................................................................................................
6. If ',business, commercial or mixed occupancy, specify nature and extent of each type of use ................................
7. Dim~0sions 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 ........................................
B. Dimensions of entire new construction: Front ......... .],O ............. l~ear ........... ~g, ........... Depth ....~.Jl, ...................
Helght ............................ Number of Stories ..... O1~ ................
9. Size of lot: Front ......... IOQ ........... Rear ........ 1l~10 ............. Depth ...:~9,~'...p~t;:ill ..........
10. Date of Purchase ........................................................ Name of Former Owner ................. llJ~...~.'leJtll~l~ ............
11. Zone or use district in which premises are situated ............ ...u]~ ...........................................................................
12. Does proposed construction violate any zoning law, ordinance or regulalion? ............... ~ ..................................
13. Name of Owner of premises .......... ~,....~lt, l~. ............ Address ........ J]~',l.t~O.].~ ................. Phone No .....................
# ............................................ Phone No .....................
Name of Architect ................................ Il ................... Address
Name of Contractor
.................................................... Address .................. ~.l. ........................ Phone No .....................
PLOT DIAGRAM
Loc.ate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block numbers or descripti )n according to deed, and show street names and indicate
whether interic or corner lot.
/
STATE OF NEW YORK,
COUNTY OF ..... I~.~.o,~ll: .......... f S.S.
.......................... ~],Z~.~I,~,..JJ~I~t... ......................................... being duly sworn, deposes ond says that he is the applicant
(Name of individuol signing application)
above named. He is the ............ (~e.~ ..... j~.:J..~:~ .........................................................................................................
~I (Contractor, agent, corporate officer, etc.)
of said owner or owners, ond is duly': authorized to perform or have performed the said work and to make and file
this application; that all statements,:c, ontained in this application are true to the best of his knowledge and belief;
and that the work will be performed., !n the manner set forth in the oppliFation filed therewith.
Sworn tobeforemethis ' i" ~'~,J~lg 0
.................. Z3...( z/ .z. / . of ........ 1761 ...
~ ~--~ ~,. · ............................................. ;.,.~.:¥.~. ~, .........................
Notary Publ,c, ,.~(~r.i~,~,.j~.i(~Ir/~:;,.~.~.~.'F.~..-,-X..'F~. C~un~'/ .~ .// (S,gnature of applicant)