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Home My WebLink About6581-zFOK~ NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z7639 .... Date .......... [qay. · .~ ......., 19.,~. THIS CERTIFIES that the building located at . Xenney Road ............ Street Map No. Y~e~ood Block No ........ Lot No. Lot 1.$ .&12 · · · 8our;hold ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated Ml~r 18 & 29 .. , 19 7.~ pursuant to which Building Permit No..6~8.~Z .&6690Z dated I~y ~8 & l~lay 29 , 19. ~.~, was issued, and conforms to 411 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~.ivate .one .family dwell ~g. vith addi~i, on. & aee~ss~er~ .b~Aitding The certificate is issued to Waltel' F. &. Emma. ~ean Harri. · a .... 0wlae~,~ ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N,tlo ............. UNDERWRITERS CERTIFICATE No .... N~28. .............................. HOUSE NUMBER ..... .1 ~9~.. Street .. Kanne~ Hoad. .... South~14 ........... .... l'c~i~g Ii~ FO~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING FERMIT Cf'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o. ~s~ z ~,~.. ................. ~..~ ...... ../.~....,~,.~ Permission is hereby granted to:, I ^ ........... I~.~.....~ ........................ at premises located at .... ...~.......L.(..C.~../....~... ........ ~..~.. ............................................ .................................. ~ ........ ~.~.~...~ ........... ~!~. .................................. ~i[d~n~ [~spector. ~ee ~ ...... L~...~ Building Inspector FORM NO. $ TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 AFFMCATION FOR CERTIFICATE OF OCGUFANGY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the fallowing; for new buildings or new use: 1. F.nal survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buildings and installations, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicob|e. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Dote ............................. ~ .................. New Bctilding ................ Addition ~ Old or Pre-existing Building Vacant Land Location Of Property .../...'~..~.~..~.. ...... ./..~..~.:../~...N...~-.~'.....~. ........... .~..g..~.....7~..., ............................................................ Owner Or Owners Of Property .... ...... .e.:-......k.......~..~.../~.'~!.~ ......................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No, ~(~ ~6 ~-- Date Of Permit .,~/.Z,~/~,.~,..Applicont /.¢/J~ L-~.-T-~ ,~,,,,~ ~1~_~ Health Dept. Approval ...................... ; ....... ; ............. Labor Dept. Approval ........... .,A~..~;..,!~: ........................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ .......... ..~...~..'~... ............... Construction on above described building and g,e, rmit meets all applicable codes and regulations. /~// '.~s'~""- Z./ ~ , ' Applicant ../~/.~...~..~. ' ./.'..~ ................................................... Sworn to before me this _c day of Notary Public ...... ~~ .... County THE NEW YORK BOARD OF FIRE UNDERWRITERS ak .,. ~-. BUREAU OF ELECTRICITY ~ - [' I ~;~' ' ~ ~ ' EE JOHN STREET, NEW YORK,: NEW YORK 1,0038 ' ~ exami~n :~ A~-~' ~q :;[ -~ ~7 :~ ~dfound tobe'in compliancewith ~he r~uirements of h~ EXFIAUST FANS ~outho~d, L.~. . ~ - This c.~iflcote must-~t ~ o..red in ~ny men.rr refurn ,o the office of the ~rd ACCUSATORY INSTRUMENT INFORMA%ION - GENERAL. C P.L. lDO 't5 FORM NO. 2.56 STATE OF NEB' YORK : COUNTY OF ........ __s..u.P_.P_.°_~__I5 ....................................... _ __,.Itls,'v_ T O, F, ..... C O U R T ......... 'I'D_-w1L ........ 0 F ...... S.O. UW.,,~O. LD ...................................... ~l!r ~r~plr ~;f tl,~r ~tatr af ~'eal tj~rk ___~__ ~___~___~.~._ ~ ~n__~_~_~.L$_,__.~_, ........... Defendant 3nfurmutitm ~--J~9--c--k--e`y--c-r--e-e--k----D.r_i-v-e--~-.-s9-u-t-h-°-~--d-~--N~9~-w--¥-~--r--k-- ................. , by this information written accusation as follows: That---~W~-a~-~--t.e-r----F--.---.a--n--d----E-~-m~---a---J--e~.a--n--~-H--a--r--r-i-s--~--Q-F-: ....................... , on the._._q da~ 0fJanua_rff 19 77 _, Kenny's Road; Lots ll and 12 (Location) in the ....... _H_ _a_ _m..]._.e_ .t_ ................... of ...... _S_o_u_ .t_h _o_1_ d_ ............................................. CounD of ...... $_.qg_~_.o._l_.k_ ....................................................................... ,New 'for commit the offense ~f~--°--c--~-u--p-zi--n-~-.a--d-d--i-t--i~-°--n-~-°-n----e-x-i-s-t-i--n-g-~.-d--w~-E3-~D-9-~-~ a (mi.s~m~.aa;~) (violation) in violation of Section __A._r._t_.__._X_!_V_,___S__e__.c_.____]._(I~I=i~__A.__LI_)__ Chapter t00 of the Code of the Town of Southo!d ..................... I:aw~of-t-}re-Sta-te-o~-l%w-kq~rle, in that (s)he did, at the aforesaid time and; Count0ne: occupy addition on existing dwelling located on the above captioned premises without applying for or receiving a Certificate of Occupancy. Thefactsupon whichthisinformationisbased areas ~llows: Walter F. and Emma Jean Harris, Jr. obtained Building Permit ~6690Z on June 26, 1973, and constructed an addition onto an existing dwelling. To date, the defendants have not applied for a Certificate of Occupancy, although they have been motified by mail that they must do so. --- Walter F. and Emma Jean Harris, Jr. ~'here[ore, Complainant prays that ................................................................. be dealt ~ith pursuant to law. Complmnant Howard Terry, Building Inspect, *~Subscribed an.d Sworn to. la.e fore me on ................ ............................ '/fl Title or Ofhce = J t The forego;ng factual oJJegahons are based upon personal knowledge of thc complainant (and upon ACCUSLTORY INSTRUMENT INFORMA'JION - GENERAL C.P.L. 10Cl 15 FORM NO. 256 WlLL~SO~ LAW J~gOK CO nOCHES'~LI~ h ~ STATE OF NEW YORK COUNTY OF ......... .8._U_F__F_Q__~_. .................................... __.,.ILIS m 'r ~ ~. ...... C 0 U R T ....... X_Q__.~'q' .......... 0 F ..... ,~.QU_~'.,E.OJ.,D .................................... ~t!r ]~rnplr ~f ti? Slate ~f ~Nru, ~rk ]nfnrmation ' - ~-a- ~-%'e- 'r' - E -'- -~ --~-a' -~-e -a -n- -- ~-a- -'r-r-;k:~' '--xTx-"Vefenaant ........... Howard Terry.._B.g_i__I_d__.i_n__q__I__n__s_]2e__c__t_g_r ......................_' .... .~__, resid --~-J.-~.-c--k--e~-~-c-.r--e-~k---.D-.r-i--v-~e--~----S-~--u--t-h-~-~-d-~---N-e-~=~- ................ , by this information written accusation as follows: r h a t _ _ _ .W_ _a. _1. _t_e_r. _ _?_ -_ _ _ _a_ _n__d_ _ __E_ _r~_. _a_ _ .J_ _e_a__n__ _ _H_a_.r_ _r_i__s_,._ __J_.r_ x ........................ on the___} da~- of_.J__a_n_u__a__r_Y__ ! 9_72 ........ at .... _K_e__n__n_Y_'_s___R_°_a._d_L_~_°__t__s____l_l___a._n__d_.~_ ................. (Locatmn) in the ....... _I-] _a..nj _I_o_L. L ...................... of ...... .S_o_u_t_ _ _q _1..d_ ............................................. Count~ of ......_8_ _u_ _~_ f_ _o_ _l_k. .................................................................... ,New Ym commit the offense ~-~-9--c--c-u-p-y--i-n-5~.a-~d--d--i--t--i-~-.n~-~-n---e-x..j~st--i~-~---~-¥-9-~.~.~X$~.~-~ a (a~-sg~m.anor-) (violation) in violation of Section ._g=_r._t_.____X_!__V.,.__$_e_~.~.__l_Q_O_.-_~.~__.A.__LlD_ Chapter 100 of the Code of the Town of Southold __.-.,_-_-_r_r_r_-_-_r. rl:awr~f-th-e-Sta-te-r,f ~-Ne'or-SB-rle, in that (s)he did, at the aforesaid time and ,. C0unt0ne: occupy addition on existing dwelling located on the above captioned premises without applying for or receiving a Certificate of Occupancy. Thefactsupon ~hichthisinformationis~asedareasfollows: Walter F. and Emma Jean Harris, Jr. obtained Building Permit #6690Z on June 26, 1973, and constructed an addition onto an existing dwelling. To date, the defendants have not applied for a Certificate of Occupancy, although they have been notified by mail that they must do so. -- - Walter F. and Emma Jean ~arris, Jr. Wherefore, Complainant prays mat ...................................................................... be dealt with pursuant to law. *~Subseribed and S~orn to before me on Complmnmat Howard Terry, Building Inspect. Town Justice Title or Office *set fo~h statutory language constituting the offense The foregoing factuc~l allegations =re b=sed upon personal knowledge of the compla,nont (and upon ,nf, and belief, the sources of complainants mformal~on and behef being, ACCUSATORY INSTRUMENT INFORMATION - GENERAL C.P L. 100 1S FORM NO. 256 v,l~.kJ^~,sow~.~,w Boo~ ce ~gCH[ST£m m V STATE OF NEB' YORK : COUNTY OF ......... _S__U_F__F._O_L_K_ .................................. ___~IU_.~ m'r c w. .... COURT ......... ~_Q__WI'J ........ OF .....S.O_U_TilDJ.~ ............................. t, 3nfurmatian . ___w_a_ Xt~_ .r_ _ F_ _._ ___~.__ _ .Zr~___a.__J_e_ _a_n__H_a_ _r_r__~.,_ __~Tj: ............. ( Defendant '~ ---J-°.-c.-k~-~-~-C--r--e-e-k-~-D-r--i-v-e-~--.-s-°--u--t-h-q-~-~--~-~-~-X.~X~ .................. by this information written accusation as follows: That Walter ~ and Emma Jean Harris~ Jr. ~ .................. :_ .................................................................... , on the__3 day o[.~_%_n__u_a__r..y__. 19_7_2 ........ at ____K_?_n_n_Y_'_s____R__°_a_~l__L__°_t__.s___l-.]:__~_n. ~___1_2_ ................. (Location) in the ....... __H.a__u}_ Z__e_t_ ................. o{ ..... .S..o_ .u_ .t_ h_ 9. _1_ _ d_ ............................................ Count) of ..... S._u__~_~.9._l_k_ ............................................................................ , New Ym commit the offense of occupyin~ addition on existing, dwellin withoul a (mi-s~m~) (violation) in violation of Section ..A.K.t_.__.X__I..V_~___S_.e__.c_..__X.QQ_-_Z~.~__A.__LI&. Chapter 100 of the Code of the Town of Southold ....................... l::a-~-~f-th~-S'ta'tu'~rf-l%~ 'Shcn'k-, in that (s)he did, at the aforesaid time and ,~ C0unt0ne: occupy addition on existing dwelling located on the above captioned premises without applying for or receiving a Certificate of Occupancy. Thefaetsupon ~hlcht~sinformationishasedareasfollows: Walter F. and Emma Jean Harris, Jr. obtained Building Permit #6690Z on June 26, 1973, and constructed an addition onto an existing dwelling. ~o date, the defendants have not applied for a Certificate of Occupancy, although they have been ~otified by mail that they must do so. Where[ore, Complainant prays that~--W-~a.~-.t-e--r--~-F-:-~--a--n-d----E.-ra:?--a-~-J-e-a-n--~-H--a--r--r-i-s--~--J--~-~- be dealt with pursuant to law. **Subscribed and Sworn to before me on Complmn~nt Howard Terry, Building Inspect~ Town Justice Title or Office *set forth statutory ]ang'aage constituting the offense The fo,ego,ng factual atlegat,ons ore based upon personal knowledge of the complo,nant (and upon info and beJ*ef, the sources of complainants ,nformat~on and bel,~f be,ng, ACCUSATORY INSTRUMENT INFORMATION - GENERAL C.P.L. 100.15 FORM NO. 256 WILLIAM$ON LAW BODK CO . ROCHESTER N Y 14609 sT~r~, or NEw YORK : COUNTY Or · ' ...... [T'~ ..... 77 ............................................... __~._coL~r ...... '.~~ ..... o~_...~~.~ ........................................ 3nf~rmatimt Defendan[ .... ~ ~ ........ ? , _. . ..2 .... '~.._( ............................................. by this information makes written aecusatton as [ollows: in ~ ....... Z~~~ ................ ~.._~~.~. ................................................ , C...t~ o[...~~ .................................................................... ,New Yo~k, a ~~vlolation)in vtolation o[ Seetio~x{~.~.Zm..!..~.m...~..[..of the State of Sew York, in tha~e did, at the aforesaid time and place* Count ~e: ~/~ The facts upon which th~s mformauon ~s based are as follows] The foregmng factual allegations are based upon personal knowledge of the complainant (and upon informahon and behef, the sources of complainants ,nformat,on and belief being, APPLICATION FOR BUILDING PERMI1~ ~ %G~ .. JNSTRUCTIONS .... a. This epplieation must be ~mple~ly filled in by ~writer or in ink and submi~ in tripli~te to 3 ~ of ~am, ~ura~ ~ot ~an to s~le. F~ ~di~ to ~ule. b. Plot ~ ~ing ~tion of lot and of buildin~ on premiss, relationship to ~joining premiss or ~lic ~vi~ a ~ ~i~ of layout of ~o~rW must ~ ~awn on di~ram ~i~ ~ ~ of this appl~tion. o. ~ ~ ~md ~ this appli~ti~ may not ~ ~m~n~ ~re i~u~ of Buildi~ ~rmit. d. U~ ~ll of ~il ~li~tion, t~ Building Ins~or will iss~ a Building ~rmit to t~ ~li~t. ~ ~/~lil~ ~ ins~ th~ou~out the ~. e. ~ ~ ~ ~ ~i~ or u~ in whole or in ~. for any pur~. whate~r udfil a ~ifi~ of ~LICATI~ IS HEREBY MADE to the Building ~nt for t~ i.uanm of a Buildl~ Permit pu~ ~ ~ ~lld~g Z~ O~t~ ~ ~ T~ ~ ~old. ~ffo~ ~unW, New Yo~, ~ ot~r applique ~l, ~ina~ or ~, ~ ~ ~i~t. or for m~val or ~m~ltlon..~ ~rein ~i~. ~, ~l~ ~, ~ ~, and ~ulatlons, and to ~mit authori~ in~o~ (Signature of applicant, or name, if · corporation) (Address of al~llcant) State whether applicant is owner, levee, agent, amhitact, engineer, general contractor, electrician, plumber or builder. Name of 'owner of premises ....'~'&~.t~lg..~.e...lG~..]~llll..4~lll~,,~l,l~'~Ll..aTl~/, ............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder', License No .......................................................... Plumber's License No ......................................................... Electrician's License No .................. Other Trade's License No ................................................... 1. Locetion of land on which pro~ work will be done. Map No.......~...~.. 3.3. b 1 ................................ Lot No ................ .~. ..... Street and Number ...~..]Le~al. ..................... ~..~. ........................ : .................................... ':'~t~ .......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · . o'n® 11'1l~3,1'.:]~Ili,11'I - . a. Existing use and occupancy .......................................... ~ ........... ,~ ..................................................................... b. I ntendeduse.~mdoccu pancy ............................ ~;...... ................ ~.....-~ .......................................................... ~'o 3. Nature efWork (check ~r~hi~a~olicable): New Building ....................... Addition ...~ ............. Alterat~n ...... ~...,.. Repair, ................ : ...... Removal ......................... Demolition .......... ~ ........ ,.... DtheFWork ,. ........ ~ ................ ~ ...... ~ - (Description) $3e0e,oo Estimated Cost ........... , ................................... Fee ........................................................................... ~ ................. (to be paid on filin~ this application) If dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... If garap, number of cars ......... ~ ........................................ :. ........................................................................................ If buslne~, comnferclel or mixedoccl/oancv, specify nature and extent.of eeoh type of usa ......... ; .......................... Dimensions e~f existing structures, if any: Front . Dimemions of same structure with al .tm:.ations or additions: Front ..~...A-~ ............ Rear ......~,~ ........ ;.; ................ 8. Dimandons of entre no~cgn~mction: Front ...................... Rear ............................ Depth ................................. Height ................................... ,. .......... Number of ~orlee: ......... ; .............................................................................. g. ~ze of lot: Front ............... ~ .................... Rear .......................................... Depth .................................................. 't962 ...... 8 o~tho3.d, dove1 o~aent 10. Date Of Purr. ha~ ..................................... r~eme OT former uwner ........................................................................ ' 12. Does ~olx~d construction violate any zoning law, ordlnenee or relNlatio~: ..... .a~ ................................................. 13. Will lot be reinded ----a-°~ ........................... Will exee~flll be removed from Ixemiles: [ ] Yes [~ No .. , ~. ~. ; _ _ (Address) . ~ (Phone NO.)' Name of Con ~ ................................. , ............................... ' ' ~ PLOT DIAGRAM ~xaM =~fly ahd d~ MI~ hfl~np, wh~h~ ex.n0 or pn~o~d; a~d ind~aMall, m~eek~dlmen~om from pro~er~ Iin~. G~e ~m~.md b~x~'nu~b~'or i~ion ~lng to~ end thow Itmet nmos'and ind~e wh~h'"4- er intedor or =ormr lot. ' ~ ' .... ;'~ ~ 6; STATE OF NEW YOf~d~ ' ) COUNTY OF ....'. .......... .-w~...f ~.... j....,....~L..~.) y ........ /~r.~~;~,,/,.,~.... ~..: ...... being duly sworn, deposes ~nd says that be is the applicant above named. ~ f~trne Of.lndlvl~, df. lng contract) . ; - .o i, the -- -' ......................... i ................... ..................................... (~ontrAvtor," . A~ent. corporate o. fficer, etc.} of .aid owner or owners, and i, duly euthori~l to parforg01[Hhlkva~rm.d the ~lid work and to make and file this application; that ell ftat.ment~ contained in this application are true to I~lhlll~kPch~llpmdvl~¥.~ld ~bei~i.f: and that the work will be parform.d in tbe manner ~et'forth in the al~lication filed there~ No. 52.034~,963 S.u.ffqlk Coun!~ ...................... Disapproved a/c ._.~ ................ XffLICATION FOR IUILDINe PEI~4IT ~.Z...J..... a. This application mu~t be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, w 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan ~howing 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 Ixoperty mu~ be drawn on diagram which is ~ of this application. c. The work covered by this application may not be commancad before issuance of Building Permit. d. Upon appmvai of' this alNdication the Building Inspector w ssue a Building Permit to the applicant. Such permit.shell be kept the premim available for inspection throughout the ~ork. or ,n who,. or ,n pa.,or any pu. . wh.te., un,,, , ...,,,cate o, hav. · · APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit purwant t0 the Building .Or.d.i?nce ~.f,.tl~. Town .of So.uthold~ Suffolk County, New York, and other applicable Laws Ordinances or ~, ~ the construct on~ ou,om~, aa~t;ons or alteratmns, or for removal or demolition, as herein described. The applicant agme~ to comply ~ MI qRdical~e ordinan~, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in I?ildi~lS for neee~aW in~ectionl, (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, I~, agent, emhitect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporel~, signature of duly authorized officer. IName and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ....................................................... Other T rade's License No ................................................... I. Location of land on which proposed work will be done· Map No.Z~f....~...[I...'. .......................... Lot I~1o. ~/4(...~.../....~........~. Street and Number ..~ ..... '... ' .~.~..'~... .... '.~ ........ .... ~, ......... a~,,~.. ~...C.~ ........................................................ 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~,, ~tum of work (check which applicable): New Building ....................... Addition ..................... Alteration ...... ~..~;.. Repair ......................... Removal Demolition ........................ Other Work ......................... ~ (De~scription) 4. Estimated C~st ,~,..~.Z .~.... ........................... ==' //~ ' ~" ....... (to be paid on filing this application) If dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... if garage, number of cars ................................................................................................ .. · ...- · -. · · '- " 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of usa ..................................... 7. Dimensions of existing structures, if any: Front ...~. ................ Rear .....~. ................... Del)th ......~....~. ....................... Height ...~.~ ................................................. Number of Stories...J....~...~.... ..................................................... .. . ..... · · .. Dimensions of same structure with alterations or additions: Front ..... .~. .................. Rear ....~..?. ............................... De,th ......~1~....~..~ ................... Height ......~...o. ............................... Number of Stories ..../...t./..,~.....,,., .................... 8. Dimensions of entire new construction: Front ..... ~.;.~...~ ....... :.. Rear ...... ~..~ ............. Depth ...~..~..../.. .................... / I-lelaht ...~. '~ .................................... Number of Stories ...,....~ ........................................ -.....~ ............................... 9. ~iz~of lot: Front ../...~?~..~ ........................ Rear ..... /....47..~..../. ........................ Depth ...../.~...~. r 10. Date of Purchase .~.~..~.~------ .................. Name of Former Owner~ '"~- ' ~~""" 11. Zone or usa district in which premises are situated ~J'~'~/~:~'~v 7-/Z) 12. Does proposed construction violate any zoning law, ordinance or regulation: ..--~... ...................... 13. Will lot be regraded ..... ~(~"~*'-~"~'"'~~ ,--- ,, - ,, -- o,-- ,,_--~,---~--,,,Will excess fill be, removed from pre .misas: [ ] Yes ~ [,~1 No 14. Name of Owner of premises ,~...~......~.:.~....~tc~,,~.../R.~..'f~Z'..~....tr~-.Z~..~...:'_.~.ff~:.~: ................ {Address) ~nor, e Name of Architect ......................................................................................................................... ..... ...... · -. · -- · .. ----- " · (Address) (Phone No.) Name of ContraCtor .......................................... ~ ........................................................................................................ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end indicate all sat~oack dimensions from property lines. Give ,[,~et and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) ~ COUNTY OF ...................................................... ) (Name o/individual signing contract} 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 ell 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 there~.~th. ...................................... day of .................................................. 19 ............. 't (~ q