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HomeMy WebLinkAbout2064-zFO.R~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~,...~..~9 ............. Dote .................I)eoeaJbe~.....~,8 .......... , 1963 .... THIS CERTIFIES that the building located at ...JJ/J~..J~C~Cj.'JO..][~J~&~,(~,,~..,~'~) ............ Street Mop No ..... ~ .......... Block No ...... ~ ......... Lot No. ~ ........... S'Qu.thold .............................. conforms substantially to the Application for Building Permit heretofore filed in this office doted ....................................... J~.~.....~.J~....., 19~3... pursuant to which Building Permit No....~0~.~iY~ doted ....................... M~ ....... ~ .............., 19./O,~.., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ...l~u~.~,ne ~..l~.~.%cl.L. ng...,~..~.Z~,~...~r~e..&.. ~e~e...e~Le.e..~¢~.o~ ............ The certificate is issued to ..R.,...~oee~h..~hee.Z.e~ ..................................... ~to~, ......................... (owner, lessee or tenant) of the aforesaid building. FORFI NO. 2 TOWN OF SOUTHOLD BUILDING DEPART/v~ENT 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.° 2o64, Z Dote ............. ~i~.~/' ' '" 2'8 ............................ 1~-3~ ..... Permission is hereby granted to: ~ ;.~1,4~ ~.~. ~g~.~r ~, .......................................... ...... ~6~'~'~'"~ ............................................. .............. ~6~tf,~l'~ ............................................... to · Bii'f Ii~'"i~'~'"tii~ ~'~'~" I~'~ I~'~ ......................................................................................... at premises located at "'~B"~B~]~"'E6J~ ..................................................................................... ................................................... ~ ~'"tK ~; ............................................................................ pursuant to application dated , ~ .19...~..,, and approved by the .................................. ~r~""]i~' ...... ~3 Building Inspector Fee $"[0; 0'0 .......... Builaing inspector TOWN E]F SDUTHnLD HFFIE]E OF BUILDINFI INSPECTOR ToWN nLERK'S OFFtOE S[DUTH[~LD, N, Y. c~or'~m~ ~orS~ r o~'~.j~lWor ks Suffolk County Yaphank Ave.~ Yaphank, N. Y. Dear Sir: In accordance with Section 23C)K 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 ...................................... · .~o~e~-..-Jo~e~h..~l~ee'Ze~ .................................................................. ............ ;tte&eCeam..A.Ve,...Sem-thei~,...N.,.~., ......................................... has opplied to the Town of Southold for a permit to construct a building on ....N/S..~&~t~i,..~t...(...¢~.Zl.~.~t.~i.),..~t~h~i~.~...~,.i~., ............ as shown on the attached plot plan, submitted in triplicate, da}ed ................ ~.....~.,~/.~....~.~ ............ and titled '"~&~e~'"~'"~'~..~.~.~-~l~l~ j We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 239K. Very truly yours, Building Inspector Town of $outhold, N. Y. TOWN ElF' SOUTHL3LD DFFIOE OF BUILDING INSPEBTOR TOWN rZ. LERK'~ OFI~$BE mmJssloner ot MUDUC works Suffolk County , Yaphonk Ave., Yophank, N. Y. Middle Road OR 27A Dear Sir: in accordance with Section 239K of the General /V~unicipal 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 ...................................... has applied to the Town of Southold for a permit to construct a building o. .... N,,i'C . .. .( . . ,, A.*/ A. ) . . . ,, , ........... as shown on the attached plot plan, submitted in triplicate, dated ................ We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 239K. 6/20/63 Approved to the Town o~' Southold pu~suaut to Sec. 239K 02 Very truly yours, the Gen'l Municipal Law; and before building access to .the County Road, . applicant must obtazn a permit under/ . Sec. 136 of the Highway Law; no tree's to be removed by owne~. SUFFOLK COUNTY DEPT PUBLIC WORKS H. ~. Bishop, Co~issioner · Wfllia~ S. Matsunaye,j~ Chief Engineer Building Inspector Town df Southold, N. Y.  STATE [3F NEW yF'IRK DEPARTMENT BF' LABEIR DIVISION OF INDUSTRIAL SAFETY SERVICE 80 CENTRE STREET ~r 20, 1963 NEW YORK 13, N.Y~ CERTIFICATE OF APPROVAL ~-,zv~s~o~ o~- ~ous~-~.. (BUILDING PLANS) oow~o~ ALFRED E. SMITH STATE OFF~CE BUILDING r ~ ~-0~0 Hr, ~, J, Wheeler ~s~a~,~ ~A~t~t~o. 9oisseau Avenue ~ F~o,~ ~ a~. S~t~ ~] ~ o~ Southold~ ~ew ~ork Ow~,. R, J, Wheeler N~ ~oute 27A~ ~00~ ~/o ~oisseau Ave L ~o~no.: Southold~ Suffolk Co. [~outhold Auto ~ales) The plans ~d specifications bering the .st~p ~d sari~ n~ber of ~he ~ew ~ork ~ ~ep~ent of L~bor cited ~bove a~e ~n compli~ce with r~qu~rem~nts of the Lair ~aw and tRe ~ouarrl~ ~ooe ~ APPROVED as t~gOVED ~i~h e~dition~. Val~ onl~ after ~he con~ion~ ~eg forth On a~tached Reference Ae acting. Sheets NOTE: The main entrance door to the office shall o~en outwardly or be double- 1-2 b, d; 2-3 b, c; 3-1 a, b, c, d; 3-6. Effective April l, four sets of plans and applications will be reqnired for future submission. This determination is valid only on the basis of the statements set forth in the application for amination of plans bearing the same stamp and n~raber aad to the extent that such pla~a are subjec~ to the ~visions of ~aid law ~d code ~d w~ia the jurisdiction of ~e ~dusui~ Commissioner. No~ ~e B~ldiug Pl~s En~neeting Unit of any ~v~sed deviations f~om these pl~s; fling of ~v~sed pJ~s may he ~equi~ed in these instances. A set of pl~s shoffid be re~lned on t~*e pmmiges at all times so that inspectors of t~s dep~ent may consult them ~n the co.se of their A cerdgicare of compli~ce mus~ be obtained, PRIOR TO OCCUPANCY, for: L Any buil~ng to be used as a FACTORY ~ith more thau five employeeso Apply a~ least zen days prior m occupm~cy, m the Supe~ialng Factory Ins~ctor, Dlvision of Industrial Safe~ Service at 2. Any building to be used as a place of PUBLIC ASSEMBLY. Apply to local building official or, if none, to Supervising Factory Inspector, Division of Industrial Safety Service at This is not a building permit. To obtain required permit take this certificate, with the approved plans, to the local official° The Department of Labor ~ssumes no responsibility for the adequacy of the structural elements involved itl the construction. A4,~_~ Eno. loc, plans & appls.~ 5 ISS 600 lc Isol~, + plan & appl. Har~y Silberberg, Assistant Director FOR THE CO~ISSIONER ISS-640 { 4.-$3) Permit N o..~2r.~'~l ......... PERMIT UNDER SECTION 136 of ARTICLE VI o~ HIGHWAY LAW WHEREAS, a certain highway known as the i~t~L~f~ ~en improved a~ is on the Suffolk County Road System and NOW, TH~EFORE, pemission is hereby ~anted ~ said to do said work upon the following conditions: CONDITIONS AND RESTRICTIONS 1. When concrete Is removed, cut concrete with eenerete saw two feet outside the limits of the proposed excavation and for the full panel width. V~hen the cut is made in pavement within 10 feet of the panel joint, the pavement shah be removed for full panel width from the cut on the far side of the excavatlen to the panel Joint. 2. Backfill and thoroughly compact fill using power temper, placing soils so that various types of soil are in same relative position as before excavating. Grade to original surface. 3. Replace pavement, sidewalk or surface same as existing; ff concrete, replace using 1:1~:~ mix stone mix concrete; ff bituminous material, replace using same type as removed. 4. If concrete curb is removed, repinee with similar curb l:l~:S~ mix. 5. No~ify the Maintenance Department at Yaphank 4-g451 when the work is to begin so that an inspection can be made of the operation. This permit shall not be assigned or transferred without the written consent of the Commissioner of Public Works. The work authorized by this permit shall be performed under the supervision and to the satisfaction of the Com- missioner of Public Works or his representative. Particular attention is called to the necessity of thoroughly compacting the back fill, which will be required by the Commissioner of Public Works. The Commissioner of Public Works shah be given one week's notice by said applicant of the date when it in- tends to begin the work authorized by this permit, and prompt notice of its completion. The said applicant hereby agrees to hold the State, County and Town harmiess on account of damages of any kind which may arise during the progress of the work authorized by this permit or by reason thereof. Applicant certifies all persons concerned with actual work under this permit are duly covered by workmen's Com- pensation Insurance and the State, County and Town shah be held harmless on account thereof. The Commissioner of Public Works reserves the right to at any time revoke or annul this permit should the said applicant fail to comply with the terrr~ and conditions upon which it is granted. The applicant agrees to pay all necessary expenses incident to supervision and inspection by reason of the granting of such permit as certified by the Commissioner of Public Works, such payment to be made within ten days from the rendering of the certified account. Work under this permit to be commenced within thirty days from the date of permit and continued in an expeditious manner. The applicant shall submit a detailed plan of structure to be built, with a description of proposed method of construction. It is understood that should future changes ih the alignment or grade of the highway require changes in the work covered by this application and permit, the applicant shall on reasonable notice from the Commissioner of Public Works make such necessary changes at his own expense within the time so specified in notice. Traffic shall be maintained by the applicant on this section of the highway while the work is in progress and until its final completion. * ~..~w Bond ~1~ me sum of $~7?~__payable to the County Treasurer of Sqffolk County is d~llb~ns security that the highway will be restored to its original condition where disturbed at the expense of the applicant, as soon az the work has been completed~ and the said Commissioner of Public Works is hereby authorized to expend all or as much of such deposit as may be necessary for that purpose, should the said applicant neglect or refuse to perform the work, In consideration of granting this permit the undersigned accepts it sublect to conditions described. TO AVOID SERIOUS DAMAGE TO VITAL UNDERGROUND G P E C LONG ISLAND LIGHTING COMPANY AT JUNIPER 2-9000 BEFORE STARTING THE WORK AUTHORIZED BY THIS PERMIT. RECEIVED lq~3 SEP-5 ~i'l 9:21 TOWN OF SOUTHOLD BUll. DiNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~...fM~..,..~.{.:.':.,.!.~~. ...... , 19..~.~ ^pproved ...... 9.. : ermit ..... ....... (Buildi~,g 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 to odioining 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 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been g~anted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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, electrician, plumber or builder. 0~f~,~' Name of owner of premises ....~.....~o.~e.z~b...~b,.,e3~,.~ ........................................................................................................ 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: ....... -.~....~.. ......................... Lot No: ...~.?~ ....... Street and Number ~f/.~:].~.c]..c.~.~.~.Q~Z~:~`~.c.~kQ~ ........................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ...~:~c~z:.~..~L~Lcl ............................................................ b. Intended use and occupancy ~1~!~2:~k~).~.F!~..?~.].5~?..~g~.-.~.~.-~).~:~g~.~.~..`~:~%~:~:~:g~ ........... 3. Nature of work (check which applicable): New Building ...~...2~....~.~.~... Addition ..................Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ............................................................ Fee .],Q.,..0..Q ........................................................................ (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. 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 ........................... Hei~lht ............................ 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 ...........~f)..~t, .......... Rear ........ ~.0..~.~ ........ Depth .....~:.q...~'.~ ....... Height ............................ Number of Stories.......°..~..~. ......... . ............ of lot: Front ...... ~.,~©...~ ............ Rear ...... J.~...~,J) ......... Depth ....... ..],~'..0.....~..~. ................... 9. Size 10. Dat~ of Purchase ............T~..~...'j..g.~..~. .................. Name bf Former Owner ....... ][JZ~,~...Q~ff~...~.~).;.L~.~ ............ 11. Zon~ or use district in which premises are s tuated ~ c~.J~,~:bz:i.¢~,....(~L:]:..~.~ee~.:...~:~;~:.~:].n..t,.?.,g.). .... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~ ........................................... 13. Nome of Owner of premises ............ ..~.~.~....~.~..~.~.Q.].-..e..?..Address ............................................ Phone No ................. Name of Architect ...................................................... Address ............................................ Phone No ................. Nome of Contractor .................................................... Address ............................................ Phone No ................. PLOT DIAGRAM Locate clearly and distinctly oll baildings, whether existing or proposed, and indicate all set-back dimensions fr( property lihes. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. i0 STATE OF NEW YORK, ) COUNTY OF ,.~$~.~,.O.,"L].~ ......... ) S.S. .................. ,.~¢.,...sZ..0.,;~.~}.l....~r~.~.~.~,~. .................................. being duly sworn, deposes and says that he is the applica (Name of individual signing application) above named. He is the ........... .o.~.q.e.,~.. ................................................................................................................ ~ (Contractor, agent, corporate officer, etc.) of so~d owner or owners, and is duly authorized to oerform or have performed the said work and to make and f this application; that oll statements contained in tk;is application are true to the best of his knowledge and bell, and that'the work will be performed in the. mqnner.set forth in the application filed therewith. Sworn to b~fore me this' ................. ~.].):1:.. day of ..................... }.:~?).~.O,tt ............. , 19...6~. Notary Public, . ........................................................... County (Signature of applicant) APPLICATION FOR BUILDING PERMIT Pate .................... 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 drown on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the 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 Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. · ...................................................... (Signature of applicant, or name, if a corporation) .... B,ot sse. au ..Av s. ..8c u.thold.,.., .......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~J~...~ro~..~J,~¢ ............................................................... ........................................ 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: ....... ~ ........................ Lot No: ....~}J~r, ...... Street and Number ~'.~{~`~d~Qi~.t~s`][~.~`~'A]~:D.~.~X1~.~ ........................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ .~&~l~...~,~'ll~ ................................................................................................ b. Intended use and occupancy ~.~..8. ~.~.~J,l?,~..?....~.~.~ ~"b"~..a.~;~...l~Jk..~j~.~.....~..~..~...~.~L,Q~ ........ 3. Nature of work (check which applicable): New Building .]OO1~1Ol~. Addition .................. A~teration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estirhated Cost ............................................................ Fee .~(~(~) ........................................................................ (to be paid on filing this application) 5. If duelling, 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 .......................................................................................................... Dimjensions of same structure with alterations or additions: Front ................................ Rear ............................ Dep{h ............................ Height ................................ Number oF Stories ........................................ 8. Dimensions of entire new construction: Front .......... 60 "~ .......... Rear ........ (~O.4,,,~.. ...... Depth .....I¥~..~'~1~ ...... Height ............................ Number of Stories.....Ol~l~ ..................... 9. Size,of lot: Front ...... .,i.~,O..~ ........... Rear ..... ~...~ ........ Depth ....... ~.:~0.,,~- 10. Dat~ of Purchase ............t,1'11l~"'S~'j'"'~9~ ................. Name of Former Owner ....... ~O.~l~...r~l~..1.~ ........... 11. Zon~ or use district in which premises are situated 12. Doe~ proposed construction violate ,any zoning law, ordinance or regulation? "t11~ .......................................... 13. Nar'he of Owner of premises .............~.~.~'.~tl~].~.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 fr~ property hoes. Give street and block numbers or description according to deed, and show street names and indic~ whether interior or corner lot. STATE aP NEW YORK, ) COUNTY iOF .~.~,].~ ......... ) S.S. ................. ,.C..~,...~',~lt~.~..l~.~e~tt~ ................ : ................ being duly sworn, deposes and says that he is the applicc u~.ame or ina~viaua~ signing app icatiom above narried. He is the ............~ltillltlt~ .............................................................................................................................. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized ia perform or have performed the said work and to rnake and f this applicbtion; that all statements contained in this application are true to the best of his knowledge and bell and that t~e work will be performed in the manner set forth Jn the application filed therewith. Sworn to before me this .................. day of ..................... ............. ,3. Notary Pu[~Iic ............................................................. County (Signature of applicant) FORM NO, 1 TOWN O'F SOUTHOLD BUILDING DEPARTMENT TOWN CLERICS OFFICE SOUTHOLD, N. Y. E×omined ...... ........ , Approved ....... . ..~.?...~......~..~ ....... , 19..~..~.Pormit No...~.~....~....?..~..c.[. .......... Disapproved a/c ~ ........ ~ ....... ~ ............ ~.".~ ............. ~......~......a~o~--- Application No...~...?....¥..Tl. ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT Datd ;' . ............... 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 o~ 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 bef:ore 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 ~or 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 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of a~licant, or name, if o corporation) ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ~?~ ...................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on~h/~h proposed work will be/~lone. Map No: ............................................ Lot No: .................... Street and Numbe '.~...~... ~ ..............: ...................................................................................................................... Municipality 2. State existing use and occupancy ~ises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................ ..~..,,'~,.,.~f.:..~,.....~...,,...,-T ........... ,~,.....~-?.~..~ .................................... b. Intended use and occupancy ..... ./. .... ~,~;, ..... ~ .......... ..'~.. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Esti~qated Cost ............................................................ Fee , (to be paid on filing this application) 5. If d~welling, humber of dwelling,cunits .............................. Number of dwelling units on each floor IF gal)rage, 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 addihons: Front ................................ Rear Depth ............................ Height ................................ Number of Stories ........................................ 8. Dim:ensions of entlrenewconstruction: Front ............ ~_.~... Rear ...... .~....~.~.... Depth ....... ,~....~,~.,. Height ... ,¢4.. ~...¢Q¢/..., ....... ......... ...................... 9. Size of lot: Front~ ...... ~,....¢?.:....O. ............ Rear ....../...../'~...~.. ............ Depth ........ ../....~...'~....~. .................. 10. Dat? of Purchase ....~,...%~ ....... ~ ....... ./~...,~i'..~.. ....... Name ? Former Owner .~...~....~...¢..~..~...._~...../~...~..~ 11. Zon;e or use districtk~n which premises are situated ......... /.~ .......................................................... 12. Doe~ proposed construction vj~cte a~v zonin~ law, ordinance or regulation . ....¢:/.~ ,~,~ 13. Naroe of Owner of premises/..)..~..';{...~ddress ..... Phon~¢¢~..~.o...~...~..~_ Name of Architect ...................................................... Address ............................................ Phone No ................. Name of Contractor .................................................... Address ............................................ Phone No ................. , PLOT DIAGRAM I.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property li!nes. Give street and block numbers or description according to deed, and show street names and indic whether in~erior or corner lot. STATE OIJ NEW Y~R,I~¢~' ~/~ ) ) c c COUNTY ,OF ~(/,<(-~7~..~..) .... ~ (Nam~h~idua] signing~l.i~,~ i?~ ~ above named. He is the ...................~.~ ...................................................................................................... ~ (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this a~olidation; that all statements contained in tKis application are true to the best of his knowledge and and t~t the work will be ~[o~ i~ ~E~an~er set forth in the application flied therewith. .......... /~..~.. day~ .............. ~~~,1 ........ ~ ~//~l. ~ , £.'L;~ (t'I OF BUILD ADEQUATE DRAINAGE STRUCTURES TO RETAIN At J,, WATER DRAINING OR FALI... lNG O1~1 PROPERTY. ,Az') ,,~Z~- ,)J~ L ,~'7'~ tj b SK£TCH SHOWING CU£B. $1DEICALK' AND SHOULD£R CONSTRUCTION ADJ/ICEhET ~"0 PERMIT No. ELE I/~AI'ION , I/'t"