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HomeMy WebLinkAbout8014-zFOR~ NO. ~ TOWN OF SOUTHOLD, BUILDING DEPARTMENT Town Clerk's Office Southold, N, Y. Certificate Of Occupancy No. Z6.7.7.? ...... Date Nov 12 197~ THIS CERTIFIES that the building located at .1~.//~ .t?.o.i.~.~..e.a?i. ?..v.e ........ Street Map No..~.:F ......... Block No..~.~ ....... Lot No...x.~......S.o.u.~..hg.~.d..' ~.°?[t ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .O[..~. P...29, 19..7..~ pursuant to which Building Permit No...8.0.~..~.g. ~ .... 7,~, dated .......... ~c.~?.?...~.5 , 19 .... was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ;...;.: .7...~.:.- ............................... The certificate is issued to (owner, lessee or tenant) of the aforesaid building, l,r~.~e?:)~'~,. t, ":,..~!ov~tT~ ' " ~'~l' ?~-C)+~,7~ fi/ ~ ~/ 7~ Suffolk County Department of Health Approval .(.~.~.t..i.(~!~..~47.~:n..~¢. ;,,:~, ) . UNDERWRITERS CERTIFICATE No..~?: .~J..6.~.~ ..... qe.}...~....~.~?ff ............... HOUSE NUMBER....TqO ....... Street... ~.o.~.~ ~,¢~x~U~.. :kv:a ....................... ..... ,, / · Building Inspector / FORM NO. 2 TOWN O!: $OUTHOLD TOWN CL£RK'50FFIC£ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 8014 Z Permission is hereby granted to: ...Ma~o~...La~e .........Jame~p~ ..................... to ~.~ ,. al.~ r.a ~ions ...o~ ..~x~ s.t ~ng,..in~ s.t~i~ l,,,b ~,~. ~&.~ ~ ........................................ at premises located at ..J~/.fJ...JJG~.f~.se~%l,.*.AVe..-.t~."~'~t';¢~'~'~.'i' ...................................................... ....................................................... $.o~th~l~ ........ 1~.¥. ................................................................... pursuant to application dated ............................. ~T.t~r¢~..-..~O ....... , 19,~.~,.., and approved by -the Building Inspector. Fee $.~ ~..,.0.0. ........... STATE OF NEW YORK DEPARTMENT OF LABOR DIVISION OF INDUSTRIAL SAFETY SERVICE TWO WORLD TRADE CENTER ~ ~ ~1 ~ NEW YORK, N.Y. 10047 Addreks Reply To: ~ tt~g~,~ - CERTIFICATE OF APPROVAL (BUILDING PLANS) STAT~V: OFFICE t?UIL, DINCr CA2dPU$ ~ Factory ~Merc. Est. ~Place of Pub. Assem. The plans and speci[ications bearing the stamp and serial number of the New York State Department Labor cited a~ve are in compliance with requirements of the Labor Law and the Industrml Code and are ~-~ APPROVED as submitted ~ APPROVED with conditions. Valid only after the conditions set forth below or on attached Reference Sheets are complied with. '" · "' '" This determination is valid only on the basis of the statements set forth iii the application for ex- amination of plans bearing the same stamp and number and to the extent that such plans are subject to the provisions of said law and code and within the jurisdiction of the Industrial Commissioner. Notify the Build- ing Plans Engineering Unit of any proposed deviations from these plans; .filing of revised plans may be re- quired in these instances. A set of plans should be retained on the premises at all t~mes so that inspectors of this department may consult them in the course of their inspections. A certificate of compliance must be obtained, PRIOR TO OCCUPANCY, for: 1. Any building to be used as a FACTORY with more than five employees. Apply at least ten days prior to occupancy, to the Supervising Factory Inspector, Division of Industrial Safety Service at 2. Any building to be used as a place of PUBLIC ASSEMBLY. Apply 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 assumes no responsibility for the adequacy of the structural elements in- volved in the construction. k~:~; ~(~.~5 :~.Carl J. Mattei, Director ~ FOR THE COMMI~IONER ~' REFERENCE SHEET NO. 1 NOTE: This sheet is an essential part of the action taken on this project. It shall be attached to the approved plans along with the Certificate of Approval. Plan Serial No, 1. Approved type exit signs shall be installed over all required exits. (26.7d; 2.4; 36-2.3r). at On the main floor and over every requj~red exit from other floors where there is any regular occupancy. b. Sign letters shall be not less than 4~" high block letters with letter strokes at least ~" wide. Co Signs in u~lpartitioned sales areas, factory spaces~ and assembly spaces of 20,000 sq. ft. or more shall have letters at least 6" high with strokes at least 3/4" wide° 2. Signs shall be internally illuminated, wired on an independent circuit or circuits used exclusively for supplying power to such signs and having no switches, fuses~ plugs, or similar devices other than over current protection and switches to the distribution box~ Signs shall be illuminated at all times when anyone is in the building. 3° Signs indicating the path of egress shall be provided at all points where the direction to exits is not readily apparent. 4. All exit doors shall be openable from the inside by pressure on the door or on an approved panic bolt release device and such doors shall not be otherwise locked, bolted, or fastened during the period of occupancy. Exit doors to or from the main public ent£ance or lobby may be equipped with draw or flush bolts; key operated, of an approved type. 5o A separate system of emergency lighting shall be provided with a secondary lighting source arranged to assume auto- rustically, in case of failure of the principal lighting source, the illumination of every exitxvay and aisle and to maintain such illumination for a period of not less than 30 minutes in any emergency. An emergency switch, conveniently located and conspicuously labelled, shall be provided for shutting down the ventilat- ing fan in case of emergency. 7. (This approval is exclusive of the hoistwayo) Specifications in triplicate upon the enclosed forms shall be submitted for each elevator, dumbwaiter, escalator, hoist~ etc. (Form ISS-602) hoistway; also, it will be necessary for the elevator company to submit plans in triplicate and specifications in triplicate for each elevator (Form ISS-603) prior to installa- tion, and both should be submitted at the same time so they can be acted upon simultaneously° 8. All required exits shall provide direct access to a street or open area leading to a street. 90 All required exit doors shall swing in the direction of exit travel except as specifically exempt by applicable code pr.vis ion s o 10. It will be necessary that the craneways be equipped and guarded in accordance with the provisions of Rules 19-20.1, 19-20.2~ 19-20°3 relating to the guarding of dangerous machinery. 11. Floor operated travelling cranes having a capacity of five tons or more shall be equipped with two independent brakes and all cranes shall be provided with automatic stops, bumpers~ etc. as per Industrial Code Rule 19. 12. Transparent glass doors and fixed adjacent transparent glass sidelights shall be properly marked and constructed, to prevent personal injuries to all persons frequenting any area, building or structure where such doors and sidelights are located, in conformity with the provisions of Rule 47. at All such transparent glass doors and sidelights shall be marked in two areas on the glass surface at a point between 30 and 36 inches above the door s.ill and between 60 and 66 inches above the sill with clearly discernible designs of opaque material as per Rules 47°7, 47.8, 47.9 and 47.10. b. In addition to (a) above, any transparent glazing materials used for replacement in existing doors or sidelights after January 1, 1968, shall be transparent safety glazing material° co In addition to (a) above, any transparent glazing material installed in new doors or sidelights after January 1, 1969, shall be transparent safety glazing material. do When transparent safety glazing material is installed, the manuincturer~s permanent identification mark denoting safety glazing material shall be vislble on the glass after installation in doors or sidelights° ISS-640J (1-68) the s~ di~h~e~ 30" ~ REFERENCE SittEET NO. 3 NOTE: This sheet is an essential pm't of the action taken on this project. It shall be attached to the approved plans along with the Certificate of Approval. Plan Serial 1. Sanitary facilities shall compIy with Industrial Code Rule No. 9. a. Wails and ceiling shall be of non-absorbent material or painted two coats of a light colored paint0 bo The floor and base shall be of non-absorbent material co The base shall be 6" high and coved where it meets the floor° do Doors shall be self-closing. e. Each toilet room shall be ventilated by windows or skylights, the openable area of which shall be at least 1 sq. ft. for each water closet or urinal. fo When windows or skylights are not available a mechanical system capable of exhausting 35° em ft. of air per minute for each water closet or urinal shall be installed. An air intake shall be provided by transoms, door louvres or supply ducts° go Water closets shall be located in compartments with doors within a toilet room° h. If both sexes are employed~ separate toilet rooms shall be provided (and the lavatories shall be located in a toiler room or in a wash room.) (Matter in parenthesis~ factories on~yo) L Water closets and urinals shall be separated from spaces in which unwrapped food products are handled by vestibules constructed of full-height partitions and fall-size self-closing doors° j0 A dressing room for women employees shall be provided, having a net floor area of at least 60 sq° ft. for the first ten employees, plus 2 sq~ ft, for each additional such employee° ko Women's d~essing rooms shall be ventilated by a window or skylight having an area equal to at least 1/20 the floor area, or by a mechanical system of ventilation capable of exhausting 1 cu. fi. of air per minute for each square foot of 1o Where more than one and less than six women are employed~ a substantially screened space of at least 55 sq. fr~ shall be provided for use as a dressing roomo mo Toilet facilities shall be located not more than one floor above or below the regular place of work of the persons using n. Toilet facilities shall be located in and be accessible from within the building. o. Toilet facilities shall be separated from ckessing rooms by solid, full-height partitions and self-closing, full-size doors, po Toilet room partitions shall be solid° Interior sash will not be permitted unless of the fixed type and with translucent but not transparent glass lights at least 6~ above the floor. q. Trough urinals are not permissible. Urinals shall be of the individual type with sides to give privacy~ r. Wash rooms shall be enclosed by solid partitions to a height of at least 7~ (to ceiling when separating an adjoining men*s wash room)° Openings in such enclosures shall be closed by solid doors equipped with self-closing devices. The space above the partitions may be used for ventilation purposes as permitted by Rule 9-11.3 (9-10o5). s0 The number of fixtures shall be in proportion to the number of each sex as required by Roles 9-4.1, 9-10.2, 9-11.4 and 36-11.2 where applicable° to Toilet rooms shall be enclosed by solid partitions from floor to ceiling with ceiling at least 7%" high. If the boiler generates steam at a pressure of more than 15 Ibs. per square inch, it will be necessary to provide the fol- lowing as part of the requirements of Code Rule No° 14. a. Two means of escape fro~r, the room located remote from each other consisting of outswinging doors at least 36' wide. bo A space of at least 24' around and between boilers for inspection and maintenance, except boilers other than horizon- tal~ tubular or watertube type or not exceeding 30" in diameter may have 16" clear space. Co A clear space of 6" above any valve or other fitting at point of maximum extension° do Where it is necessary to go on top of a boiler for maintenance or operation~ a clearance of at least 7~ of headroom shall be maintained except for an installation in an existing building where clearance may be 36'. e. The boiler shall be enclosed in a room used for no other purpose having walls, floor and ceiling of 1 hr. construction. and self-closing 1 hr0 fire doo~So (26-15.1) 3. If it is desired to obtain the credits allowable for a completely sprinklered building, it will be necessary to submit plans of the sprinkler system in triplicate for examination as to compliance with the regulations set forth in Industrial Code Rule No. 20. tSS-640.3 (1-64) REFERENCE SheET NO. 3 (CONT.) ) It will be necessary to install a fire alar~n signal system covering all areas of the building and otherwise complying, with the requirements of Industrial Code Bulletin Noo 5o N.B. Specifications in triplicate for submission are enclosed herewith. See instructions on reverse of form fSS-604. 5. Flamnkable liquids storage (Paints, etc.) shall comply xvith Rule 12-25.7~ ao Quantities exceeding 220 gallons shall be stored in a storage room° 6. Copies of Industrial Code Rules referred to may be obtained by written request to the office of the Administrative Director) Department of Labor, State Campus, Albany, New York 12226. 7. Chapter 1008 of the Laws of 1960, amending the Education Law, now requires that plans submitted for approval bear the seal and signature of the architect or engineer responsible for the preparation of the plans° The action taken in this letter shall not be considered effective until the proper seal and signature are affixed to the plans returned~ These plans do not.have to be resubmitted to show seal and signature. 8. The sewage disposal system shall be installed in comformity with local ordinances or the rules of the New York State Department of Health~ The radiological portions of the structure shall c~nply with Rule 38° ao It will be necessary to register the installations with the Division of Industrial Hygiene~ 80 Centre Street, New York, New York 100130 b0 This letter does not constitute an approval under Code Rule 38° There are many factors affecting the installations which are not determinable from the plans° You should seek advice and counsel on this matter at the above address. c. A swinging door at least 30" (36" if subject as a factory or mercantile exit) wide shall be provided as an emergency exit from the radiation area° A maze or baffle wall to shield this door is tecommended0 No required path of exit from the floor area of this building shall be required to pass through a radiation area nor through a radiological portion of the structure if avoidable° 10. It appears that the processes to be conducted in the building will produce air contaminants which may be injurious to the health of the employees° Plans for exhaust systems to remove dust, gases, fumes, vapors~ fibers, or other impurities shall be submitted in triplicate for approval to the Division of Industrial Hygiene, 80 Centre Street, New York, NoY. 10013° 11. Incinerator and heating installations or other equipment discharging pollutants into the atmosphere must be approved° Plans for such installations in factories or connected therewith, shall be submitted to the Division of Industrial Hygiene, 80 Centre Street, New York) N°Y0 10013° If in other types of structures, submit plans to the Bureau of Air Pollution Control Services, Department of Health) 84 Holland Avenue) Albany, N.Y~ 12208° 12. This action shall not be considered an approval of the fallout shelter facilities° Plans for the fallout shelter shall be submitted for approval to the local authorities having jurisdiction for the locality involved. This local authority shall include the department, bureau, division~ agency, or person, including any joint agency or a county, city, town, or village, charged with the enforcement of the applicable building code, multiple dwelling law~ multiple residence law or other law~ as defined in Section 3 of the State Defense Emergency Act, relating to the construction~ maintenance and use of buildings, structures or other real property° Southold Town Planning Board SDLITHDLD, L. I., N. Y. 119'71 PLANNING BOARD MEMBERS John Wlokham~ Chairman August 27, 1975 Mr. Gordon Ahlers, P. E. Manor Lane Jamesport, New York 11947 Re: Norkus site plan Dear Mr. Ahlers: The Southold Town Planning Board reviewed the site plan of ~he above-captioned property at a meeting held August 20, 1975. The following sections have not been complied with. ~100-134 A (9) A complete outline of existing deed restrictions or covenants applying to the property. ~100-134 B (1) Existing contours at intervals of five (5) feet or less, referred to a datum satisfactory to the Board. ~100-134 C (3) Locations, dimensions, grades and flow direction of existing sewers, culverts and water lines as well as other underground and aboveground utilities within and adjacent to the ~100-134 C (4) Other existing development, including fences, landscaping and screening. (The Plarming Board will require shrubs and a planting schedule.) ~100-134 D (3) The locgtion, direction, power and time of use of any proposed, outdoor lighting or public address systems. ~100-134 D (4) The location of and plans for any out- door signs. Mr. Gordon Ahlers August 27, 1975 Page Two The Planning Board would also like to know if your parking areas were calculated. Yours truly, Copy to Building Inspector Muriel Brush, Secretary Southold Town Planning Board SUBMIT: e) 4 COPIES OP APPLICATION U) 4 SETS OF PLANS c) CHECK OR MONEY ORDER (SEE FEE TAB~.E ON REVERSE) USE COMPLETE ADDRESS SHOWN ABOVE. STATE OF NEW YORK DEPARTMENT OF LABOR DIVISION OF INDUSTRIAL SAFETY SERVICE BUILDING PLANS ENGINEERING UNIT STATE OFFICE BUILDING ('~AMpUs APPLICATION FOIl EXAMINATION OF PLANS FactOries, Mercantile Establishments ,. :'~' and Places of Public Assembly 1. PROPOSED (Street number address, if known) WORK LOCATED []] ~ E] [] Side of .~(j) AT N0.~ast So. West 2. [~]ClTY; .,~TOWN E~]VILLAGE OF 'la. Distaat i~O , Feet ~iles J ~A, COUNTy OCCUPANCY 10. Approval of plans is requested for use of building in accordance with the following statements: 11. Total number employed at office work*__._~--'~ ................... lla. Total number employed at manufacturing*,*. .............................. 12. Will any }adiologieal devices or radioactive materials be operated, used, repaired or stored in this structure?_.....?..~.~.. ............................... 1}. Materials or a~tieles manufactured.._lb:~J~...~7~....~!...~?~ .................. Merchandise retailed ........................................................................ ........................................................................ lesaled ....................................................................... PROPOSED CONSTRU~, New building [] Addition []~. ,.,~Alteratt°n~J~ 14a. Estlmatea~ ~ .~.=~c°st .~.:~:~: .............................................................................................. Number floors ato~d.....c.a~..~ ............ ~elo,~...¢~.~ ............... ]6. Automatic sprinklers ~ [] All areas ,~ [] ~)o Access to ~djoining bulidlh~ ...................... What floor~ .................................................... By wh~t me,es ................................................... : ....... 20. Heating system:Type [] ~ ~ r~m Distribution ~ ~ ~ ~ r 21. Mearrs and methods used for window cleaning: ~ Working from safe surfaces [] Working from boatswain's chair [] Working from window sills or ledges [] Worlting from scaffolds: ' ~ Working from ladders: Height to suspension point: ft. Greatest height - Top of window to floor: ~ ft. By powered scaffold: ~ Yes ~ ~o 22° Applicants building in communities which have accepted the STATE BUILDING CONSTRUCTION CODE must complete tbe lo!lowing [or/actories and mercantile buildings: GiYe name and number designation of standards used for: C, ~t.IARDING AGAINST AlflO MINIMIZING INDUSTRIAL ,~ADIATIOI-J HAZARDS GUARDING AGAINST AND MINIMIZING FIRE HA.,~ARDS D. SAFETy OF VE~RTICAL TTtANgpO~TATiON COMPLETE, REVERSE OF THIS FORM * Office employees ilaclude stenographers, accountants, typlsts~ engLnee£s, susveyoxs, designers, draftsmen, bookkeepers, clerks, etc. ** Manufacturing includes making, altering, repairing, finishing, bottling,, canning, cleani~g~ laundering, packing, sorting, crating, etc. *** "Estimated cost" must represent the cost of the entire structure including provisions for mechanical equipment, toilet facilities and the finish surfacing of ceilings, floors, wails, partitions, etc.; all.constituting a structure ready for occupancy fbr the purposes stated on the application. EXISTING pART OF BUILDING ~' When erected: Oct. f, 1913 ................ Oct. 1, 1913]. I 23° Prior to Between July 1. 1924/ ................ Between July 1, 1924'[ After June 1, .............................. .. June 1, 1935J ................... I 3 ......... 24, Was the structure occupied as a factoW on July 1, 1948 ~ ~ by whom 25. Most reeent occupant .%~.?...~...~_L.54:...~.~'~...r~.......~= .................................... Typo of business. L."~.':.'.'..'~.....?..U.?.~';:??,..'~,:~ .............. 26. No, of stories abov~ gro~nd....(~..,.k.?..~. ........ Below...~..J~..~..~. ......... Sprinkler system over all areas El 27. Materials of wal ................................................................................... s..~. Lor~ ~ ~--tLA, ~..- Floors I~'f...t%t~.t i=, ~ ~ ~t.,, p, oofTl~t.' ~,6..~ Y 28° Have any variations been granted relat ve to features of this structure? .................................................................................................................... 29. ALTERATIONS, Describe in detail all proposed alterations, ................................. ©. ....... 30. Plot plan ................................................................................................................................................................................................................................ POINTS OF CO/~PAgS SCALE ....................... IN SPACE ABOVE DRAW PLOT PLAN OF PROPOSED WORK AND ALL CONNECTED STRUCTURES Designate each section by proper number and narhe; indicate height in stories of each section; give date of erection of each portion; plan must show entire outline of connected structures and approximate overall dimensions; sho~ north point; give name of and show location of adjacent streets, railroads, cgnals,~rivers, ]~ttild{ngs, lot lines, etc. (Distance to near~st cross road .or street rnusi Be-~hown or statedo) Telephone nu m b e r ,'~.........e...~...,..,..;~......n~. LABOR LAW -- DEFINITIONS See, 2,--g. "Factory" includes a mill, workshop or other manufacturing establishment where one or more persons are employed at manufac- turing . . . and includes all buildings, sheds, structures or other places used for or in connection therewitll, except (a) dry dock plants engaged in making repairs to ships, a?d (b) power houses, generating plants and other structures owned or operated by a public service corporation other than construction or repair shops, subject to the jurisdiction of the public service commission, . . ." Sec. 2.-11. 'Mereant'le establ'shment' means a place where one or more persons are employed in which goods, wares, or merchandise are offered for sale and includes a building, shed or structure, or any part thereof occupied in connection witb such establishment .... " See. 1-12, "Place of public assembly" shall include (1) a theatre, (2) moving picture house, (3) assembly halls maintained or leased far pecuniary gain where one hundred or more persons may assemble £or amusement or recreation, except (a) halls owned by churches, religious organizations, grange and public association and free libraries as defined by section two hundred fifty-three of the educat on law, (b) hotels having fifty or nrore rooms, (c) state and county fair grounds and buildings connected therewith, (d) grounds or buildings of agricultural societies or associations receiving state aid." INSTRUCTIONS 1. FILING REQUIREMENTS. Filing of plans and applications is required for new or altered buildings to be used as (1) factories or mercantile establishments except for buildings located in the City of New York, and (2) places of public assembly except for such places located in the City of New York or in other cities having a bureau of.buildings which ia charged with the duty of enforcing a building code enacted by the legislative body of such city, or in a city, town, or village which has assumed responsibility under sec- tion 472 of the labor law. 2. ARCHITECT'S SEAL AND SIGNATURE. The seal and signature of a New York State Registered Architect or Professional Engineer are required on plans when sueh plans are_ subject to examination by the Department. 3. EXAMINATION FEES. The following fee, based upon the estimated cost *** (see definition on front page) of construction or alteration, must be submitted together with the plans and applications, if the building is to be used or occupied as a factory, mer- cantile establishment or place of public assembly, plans will not be examined until the appropriate fee is received by the Building Plans Engineering Unit. Estimated Cost of ,, ~,onstrue~ion or Alteration Le~s than $10,000 5 10.00 $10,000 or more but less than 520,000 20.00 $20,000 or more but less than 530,000 30,00 Estimated Cost of Construction or A, ltetati6n ..... Fee $30,000 or more but less than $40,000 5 40.00 540,000 or more but less than $50,000 ~0.00 550,000 or more but less than 575,000 75.00 575,000 or more 100.00 TOWN OF SOUTHOLD '~.~., BUILDING DEPARTMENT · Approved ..........................~........../..!.-. ~.....-~..., 19...12~ No...~...~.../..~....~ .... Disapproved a/c .............................................. .~....~... / ............... ................ Date ............. '~.~../.... ~..~.. ........... , INSTRUCTIONS Application No .............................. o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises relationship to adjoining pram sas or pub c streets az areas, and giving a detailed description of layout ofproperty 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 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ..... (Address of o~'hcant) b/ / ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem,ses ......... ~,...~......~~/....~.~..~ ~ ....................... '".' ..... If applicant is a corporate, signature of duly authorized officer. V (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which~, ~ ,-~ · ~ ,.pr°p°sed work, will be done. Map No.: ........................................ Lot No ......................... Street and Number ..... ~~...~~,.,,~. ,,...~, ......... ~ .......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............... .~..~...~.~./~,~, ........... b. I ntended use and occupanc,~--~....~..~ ............................. - ; / q ............... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration Repair ...... .~...~. ..... Removal .................. Demotition...~ ........ Other Work ................................................ . ..... ~ (Description) 4. Estimated Cost .... &~.....~...~¢z. .................................... ee (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 ................. t .......... 7. D~mens~ons of eXl tm structures ~f an ' Front ........ ..?~.. .......... Rear ........... Depth Dimensions of same structure with alterations or additions: Front ......... ..~....,¢e¢... ................. Rear ...... .?....c:~.. ............. Depth ........ j..~.~-~.../. ........... Height ......... ~ .............. Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ................................................................................................... ¢ .................. 9. Size of lot: Front ............ ~..~¢,~.,...~... ....................... Rear .......................................... Depth ................................ 10. Date of Purchase ........ /..~].:f.~.?..f~,~...!..~.f...~.... ............... Name of Former Owner 1 1. Zone or use district in which premises are situated t.AJ ~7"',~ '~,~,,,,. ]2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ........ .~.~.LT.~ .......... Will excess fill be removed if~r~r, err~i~;~(~) Yes ( ) No Nome 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW,Y'OR~¢// // ~cc ~~)../.2'. being .duly sworn, deposes and says that he is the applicanl above named, z'~ He is the ............................................... ........:..........:..... ............................................................................................... '- '' -(Cont/~ctor, 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. Swam tg before rca this Notary Public~~~.~nty '-~.~~...':..~..;;..:.:..,..~?...7,...~; ....... '..~ ............. ~--/~ (Signature of applicant) No, ~2-0844963 Suffolk Count~,// / -1-- APPROVED AS NOTED DA~E:~ NOTIFY BUILDING DEPARTM~7 ED INSPiraTIONal: 1, ,BEFOR~ IA~FILL~DAL, 2. ~ COVERING~ 3. FINAL WHEN J~PLETED NOT R~pONSI~LE..~R ~E~I~N i GXIO O? F T