The URL can be used to link to this page

Home My WebLink About9949-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No z12~25 TttIS CERTIFIES that £he building --new dwellinq Przvcte Road Fishers Island Location of Property House No. Street Hamlet County 'Tax Map No. 1000 Section 007 .Block 04 .... Lot 007 Subdivision ..... ~ ......................... Filed Map No ..... .X...Lot No. X conforms substantially to the Application for Building Permit heretofore t'ded in this office dated . .. ~.7.u.l.y..2.7. ......... , 19.7.8. pursuant to which Building Permit No .... .9.9.4.9...g ........... · dated ...... S.e.p.t.e~b..ey..]: 9. ........ 19.7.8., was issued, and conforms to an of the requirements of the applicable provisions of thc law. The occupancy for which this certificate is issued is ......... a private one-family dwelling. The certificate is issued to DAVID S. JOHNSON (owner, I~ or-tefl-atr~ of the aforesaid building. 3/27/84, Robt. Suffolk County Department of Health Approval ..................................... 8-SO-104,. 486027 UNDERWRITERS CERTIFICATE NO ......... N. ........................................ Building Inspector Rev. 1/81 FO~i~ NO. ~ 'rows o~ SO~'mO~D sUILDING D~p~RTMENT 'TOWN GLERK'S OFFiGE $OUTHOLD, N~, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ":· N? 9949' Z I~otmi$$ion is horeby Orontod to: ~at~ . ~ ~'£F~T /? m7~' FORM NO'. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TEMPOMkRY Certi[icate O[ Occupancy No .... ZD/'. UT. · · Date .... F,e.hruar:~...~ ~. ......... , 19..7.9 .. ............ THIS CERTIFIES that the b~lding located at .Pr.t~at~. ' Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ~.3 ~ .....R7 .......... , 19.7~ pursuant to which Building Fermit No... dated .. ~:~.~-;;.,;~.~:~-,...~q ..... , 197~:~., was issued, and conforms to ~1 of the req~ ments of the applicable provisions of the law. The occupancy for which this ce~ificate is issued is .......... :: ~: ~ .?;:~'t;o. D, no. F~il'~t Dw.'tll!n6 .............................. The certificate is issued to ....... D~zid. Jnh~on ................................. (owner, .!e~e~r:.~E~:)t: of the aforesaid building. S~olk County Dep~tment of Health Approval ........... ~?~J,:~g ................. UNDERWRITERS CERTIFICATE No .................... ~D~36 ................. HOUSE NUMBER .............. Street ........... PV,~t~;P. ~f~ ................. ................................................. Fi~tb ~'~"~..Z~ ~6~d,. JxI %Y, ....... B~lding Inspeeto~ '~ 000~.7-4-7 FORM HO. 6 TOWN OF SOUTHOLD Building Department Town Hall · ~,~outbold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final 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, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn 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 informa- tion required to prepare a certificate. Fees; 1. Certificate of occupancy $5.00 / 2, Certificate of occupancy on pre-existing,dwelling / lend use 3. Copy of certificate of occupancy $1.00 --Pre~Existir~g C.O. $15.00 Vacant land C.O. $ 5.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... House No. Street Hamlet Owner or Owners of Property...~.. ~....~, ~¢~,~ .................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~.¢ ZTz~ ~.~.Date of Permit ~.//._ ~'~ ~"-/.~" -- ~./,~.Applicantl r '~'' ~~'~' ' '~ .... Health Dept. Approval . .' ............ ~ ....... abo Dept. Approval .................. Underwriters Approval N..ZJ/z~g .~,2. ~...~,. ...... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....... ~ ............ Fee Submitted $ ............................. Construction on above described building a,~~ets all/~p~,o~es a,~ e~a~c~s. Memorandum from o., BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN [IA I,L, POX 728, $OUTHOLD, N.Y. 1197 I 765-i802 ~/J~ Jj. McGovern President AJ. Reed Ge,lera[ Manager The New York Board, of Fmre Underwrders BUREAU O f , Da, v~d Johnson; ~ Pa~,k Area Basj~ End NEW YORK N. :y.' l~q'O~!B~ F Pu~suaint to a z,eques~ installation itt the p~em!se~ ;~i ~, ~ Fixates a~e:ino~ ins.taXied. : ~. ~m~ke ~ee~S~ ~e not, in I~; ~ill be be~o~e we a~ ~ssue a aha ~o date, j~e have hot ,o/~w ~// mpg , ~ (Q/-ound Rod) i~o ~he applican~ Memorandum from... BUILDING iNSPECTORS OFFICE TOWN OF $OUTHOLD TOWN []ALL, BOX 728, $OUTHOLD, N.Y. 11971 765-1802 SPECIFICATIONS RESIDENCE Fishers Island, N.Y. fOr David Johnson James Volney Righter, Architects 1146 chapel Street New Haven, CT 06511 March 31, 1978 DIVISION I GENERAL REQUIREMENTS 1. General a. The contract documents consist of the following: Current A.I.A. Gerafal Conditions, A.I.A. Document (B-201) . (2) Articles of Agreement (3) Specifications per Index (4) Drawings Contractor shall have full kn6wledge of and be responsible for all applicable local ordinances. Contractor shall obtain and pay for all necessary permits, inspections, certificates, and fees. 2e Insurance a. Refer to General Conditions, Art 11. b. The contractor shall carry the following insurance and shall furnish the Owner with Certificates of Coverage naming the owner as Additional Insured: (1) Public Liability: $100,000/200,000 (2) Property Damage: $50,000 (3) workmen's Compensation (4) Fire Insurance: Equal to value of Project Guarantees The general ~uarantee shall commence on the date of the final Certificate for Payment, and shhll be for the period of one (1) calendar year. (Guarantees required by Technical Sections of the Specification area part of the general Guarantee. Refer to General conditions, Art. 13.) b. Emergency and Temporary repairs may be made by the Owner without voiding the provisions of the Guarantee. DIVISION I - GENERAL REQUIREMENTS _(Cont'd) Page two 4. Performance bo By submitting a bid, the bidder agrees and warrants that he has examined the drawings and Specifications and found that they are adequate for proper completion of the Project. The Contractor shall be responsible for verifying field measurements before ordering materials and prefabricated items. Any necessary adjustments between field measure- ments or between field measurements and drawings shall be made in accordance with the decision of the Architect. The building and grounds shall be kept clean at all times. After completion of the Contract and before receiving the final payment, the Contractor shall have all parts of the building cleaned wherever such cleaning is needed. DIVISION 2 - SITEWORK 1. ~eneral a. The work consists of stripping the topsoil, excavating, filling and grading as indicated on site plan drawing. It shall be the responsibility of the Contractor to produce dumping facilities or other means of disposal for all items specified to be removed from the site. 2. Execution a. strip and save topsoil on site. Accurately excavate all foundations to dimensions details, and depths shown on drawings. If soil will stand without caving and concrete is to be placed directly against earth surfaces, excavate all trenches 1" wider each side than dimensions shown. Excavations for footings and foundation walls shall extend below the prevailing frost line and at least six inches into the natural undisturbed soil able to provide adequate bearing. d. Provide pumping to keep excavations free of water. Fill and backfill all excavations with clean excavated material if suitable or with sand and gravel. Instal]. fill in horizontal layers not exceeding twelve inches. Landscaping Earthwork outside structures shall be brought to rough grade. Topsoil should then be spread. Seed and water until grass takes hold in topsoil areas. Provide protection for existing trees adjacent to building during construction. provide select gravel driveway and turn around 4" thickness as shown on site plan. Water SDppl¥ and Septic System a. Connection to water supply shall be in accordance with local codes. DIVISION 2 - SITEWORK [Cont[d) Page two Location and installation of the septic system shall be such that, with reasonable maintenance, it will function in a sanitary manner and will not endanger the safety of any domestic water supply. The septic system shall be so constructed that the high water table (permanent, fluctuating or seasonal), will not reach the absorption area level. The system shall receive all sanitary sewage: bathroom, kitchen, and laundry. Surface water and roof drainage shall not enter any part of the system. DIVISION 3 - CONCRETE General a. Concrete tests shall comply with ASTM standards. Materials a. Portland cement shall comply with ASTM C-150. b. coarse aggregate - clean crushed stone or natural gravel not larger than 3/4 inch for slabs or 1½ inches for footings. c. Fine aggregate - natural sand, without clay content, of strong sharp particles. for domestic consumption. d. Water clean, generally suitable Installation b. Workmanship shall comply with AC1 347. Ready-mixed concrete or job-mixed concrete may be used at the option of the Contractor. c. The type of ready-mixed concrete shall be identified by compressive strength and shall be used as noted on drawings. d. Compressive strength of 2,500 psi shall be used for non- reinforced concrete work. e. Job-mixed concrete, minimum proportions shall be 1:2½:4 or five sacks of cement to one cubic yard of concrete. DIVISION 5 - METALS ~aterials a. Structural angles, gussetts and bearing plates shall be ASTM A36 steel, sizes shown on drawings. b. Pipe columns shall be standard weight, sizes shown on drawings. c. Prime paint and touch up all steel with rust inhibitive paint. DIVISION 6 - CARPENTRY 1. General a. This section includes rough and finish carpentry. Over and above the direct carpentry work, the work under this section includes the general supervision of the con- struction work of the entire project and coordination with all other trades. 2. Materials Ail framing lumber shall be Douglas Fir and dimensions as shown on drawings, or this section. Standard grade called for in Lumber shall be thoroughly seasoned, and well manufactured. Materials generally shall be free from warp that cannot be corrected by bridging or nailing. c. Wall sheathing shall be DFPA C-D with exterior glue. d. Building paper shall be ~15 asphalt saturated felt. woodwork which is to be painted shall have exposed surfaces free of defects that would show after being painted. f. Woodwork that is to be finished to show the grain shall be bright, uniform in color, and free from blemishes. cabinets and shelves shall be plywood, A, B, interior DFPA, "A" face exposed. All exposed edges shall be edge banded. When both sides are exposed plywood shall be'A-A, interior DFPA. h. Laminated plastic countertop shelves and splashes shall be Formica, Texolite, Laminart or approved equal. i. Colors shall be solid, selected by Architect from manufacturer's standard range. Finish shall be suede. 3. Installation General. The Contractor shall carefully lay out and erect all structural members of rough carpentry, framing, sheathing, bridging, and other items of work as nedessary to install the finished work. All members shall be DIVISION 6 - CARPENTRY (Cont'd) Page two Installation shall be properly braced, plumbed, and leveled. A sufficent number of nails, screws, and bolts shall be used to insure the rigidity of the construction, and to conform with the nailing schedule of the New York State Building Construction code Manual. Exposed nails shall be set for putty. Backprime all exterior millwork before installation and protect against dampness. Ail framing shall be installed closely fitted, accurately set in place to the required lines and levels. The Contractor shall not impair structural members by im- proper cutting or drilling. d. Framing joist into side of wood beams or girder shall be done with steel joist hangers. e. Bridging. Maximum spacing - 8 feet. Bridging shall be cross-bridging using 1 x 3 inch boards or solid bridging. Wall and partition framing. Unless otherwise shown, space studs 16 inches o.c. Double studs at openings. Construct partition corners of not less than three full members, wall and bearing partitions shall have double top plates. Plates resting on masonry or concrete shall be anchored with bolts. Any opening more than 6 feet shall have doubled jacks. Roof framing with rafters, valleys, hips and ridges shall be true intersection of roof planes. Rafters shall be spiked to wall plate and ceiling joists. Hip and valley rafters shall be secured to wall plates by clip angles. Stair framing shall be well spiked together. Rough carriages shall be cut to exact shape as required to receive finish oak treads and pine risers. One-half inch plywood sheathing shall be nailed 1/8 inch apart at side joints and 1/16 inch apart at end joints. Nailing shall be six inches o.c. at supported edges and twelve inches o.c. at intermediate supports. DIVISION 6 - CARPENTRY (Cont'd) Page three o Installation Finish. Exterior finish, trim, and door frames: Install straight, plumb, level, and with closely fitted joints and rigidly secured. Blind nailing shall be used to the extent practicable; face nailing shall be set and stopped with a nonstaining putty to match the finish. Stagger, conceal, or place joints in unobjectionable locations. Securely anchor door frames to the supporting construction. Interior finish trim shall be No. 1 grade 1 x 4 pine. The trim and door frames shall be set plumb and secured work with fine finishing nails and glue where required to assure permanent, tight joints. Set woodbase after finish flooring is in place. 1. cabinets shall be constructed as shown, flush construction. m. Exposed plywood edges shall be edge banded. Unless detailed otherwise on drawings, laminated plastic countertops and shelves shall be self-edged. Splash shall be square butt joint, with square self-edge top. DIVISION 7 - MOISTURE COK~ROL Section 7A - Water Proofing Below Grade 1. Materials a. Liquid Dampproofing: Bituminous Phillip Carey Foundation Coating Installation cold process coating, or approved equal. Install liquid dampproofing in accordance with manufacturer's instructions at exterior face of foundation walls below grade. Coating shall extend from foundation to 12" below grade. Section 7B - Building Insulation 1. Materials Foil faced fiberglass batt insulation by Owens-Corning or equal, 4" thick at walls, 8" thick at roof. Rigid foam installation by Zonolite Division of W.R. Grace and Company or equal, 2" thick, Installation a. Batt insulation: Staple with vapor barrier toward interior to form continuous, tight barrier. Section 7C t. - Flashing and Caulking Ma%erials a. Metal flashing shall be .032" b. Caulking shall be Tremco shall be gray. Installation a. caulk all wall b. sheet aluminum. "Mono-Lasto-Meric" or equal, color openings. Installation shall be per manufacturer's instructions. DIVISION 8 - DOORS~_~WI~NDOWS, GLASS Section 8A - wood Doors 1. Materials a. Exterior door by "Brosco" ~2130. b. Interior solid core doors by "Morgan" ~M-1053. c. Interior Hollow core doors will receive paint finish. 2. Installation a. Doors shall be installed per National woodwork Manufacturers Association recommendations. Section 8B - Finish Hardware 1. General This specification is intended to include all features normally requiring hardware. The Contractor will be required to furnish completely all finish hardware, whether or not specifically noted in the drawings and specifications. The manufacturers specified herein are intended to establish a standard of quality, utility and type of hardware to be furnished. Hardware of equal qualitY, if submitted for approval within 30 days after award of contract and approved in writing by the Architect, will be acceptable. c. Keying shall be as directed by the Architect. Ail finish hardware shall be delivered to the job in perfect working order and shall be packaged separately, marked for intended use. Furnish hardware with all necessary screws, bolts, or other fastenings as recommended by the hardware manufacturer. Fastenings exposed to weather shall be non-ferrous. f. Examine drawings and determine proper hand, etc., of hardware. 2. Materials a. Manufacturers for individual hardware items are specified below and apply to hardware numbers used in the hardware groups. DIVISION 8 - DOORS~_W_INDOWS~ GI2~SS (cont'd)- page ~wo section 8B - Finish Hardware 2. Materials b. Finish shall be US26D unless otherwise noted. c. Butts shall be Stanley full mortise, beveled leaf, 4" x d. Locksehs and latchsets shall be Schlage, Plymouth Design, 2-3/4" backset. Key locks shall have 5 pin tumbler cylinders. e. Bifold hardware shall be Stanley, with stops and track. f. cabinet hardware shall be as follows: (1) Door Pulls "Stanley" No. 4484 (2) Door hinges "Stanley" No. 331 pivot hinge (3) Drawer slides K&V No. 1305 Section 8C - Aluminum clad windows 1. Materials Aluminum clad windows shall be "Pella", clad casement, and "Pelta" clad sliding glass doors. Color shall be dark brown. Sizes are shown in window schedule in drawings. 2. Installation a. Install as recommended by manufacturer, leave all installed windows clean, tight and weatherproof. Section 8D - Fixed Glass 1. Materials a. Fixed glass shall be 5/8" L.O.F. or equal. Installation a. Install with "Tremco" 440 Compound. Tr emco. insulating glass, "A" quality. tape and "Mono-Lasto-Meric" Setting and spacing blocks as recommended by DIV%SIO~ 9 - FII~ISHES Section 9A - Gypsum Drywall 1. Materials Use ~" tapered edge type gypsum board. Use water resistant board at kitchen and baths. Installation a. Provide corner beads at all corners and casing beads where gypsum board butts to other materials. Fill and tape all joints, screw depressions, etc., in accordance with manufacturer's specifications and provide smooth finish surfaces, true planes, free from trim waves, cracks, offsets and other defects. c. Assure room temperature of 65' - 70' F is maintained during and after taping, spackeling and finishing wallboard. Section 9B - Tile 1. Materials a. Floor tile to be selected by Architect. Installation a. Tile to be installed using mastic setting method. Section 9C - Resilient Flooring t. Materials Vinyl-asbestos tile, 1/8" thick, solid colors to be selected by Architect. Use 5/8" D.F.P.A. plywood with exterior glue for underlayment. Trim with vinyl, base, Installation 4" high, solid color, with preformed Install resilient flooring per manufacturers recommendations. Install underlayment over sub floor with joints staggered. DIVISION 9 - F/N/SHES Page two Section 9D - Painting 1. Materials Materials shall be top quality of one or more of the following manufacturers: Samuel F. Cabot Devoe and Reynolds DuPont Dutch Boy Benjamin Moore Pratt and Lambert Sherwin williams ~pplication a. Follow manufacturers printed instructions. Do not paint in damp, rainy, or cold weather. b. Seal knots and pitch pockets with shellac before painting. Paint gypsum board walls with primer and two finish coats. Paint gypsum board ceilings with primer and one finish coat. Prior to painting, the Architect will furnish to the Contractor a color schedule complete with sample chips. DIVISION 10 - SPECIALTIES Section 1. 10A - Toilet and Bath Specialties Materials a. Medicine cabinets shall be Lawson %3525 or recessed, 16" x 20". b. approved equal, Toilet paper rollers, ehc. shall be Hall Mack "Coronado" or approved equal. Bright chrome finish. Mirrors shall be copper-b~cked plate glass, sizes as shown on drawings. Towel bars shall be 1 ~" closet pole (sanded) supported on handrail brackets, size as shown on the drawings° Towel bars to receive one coat sanding sealer. Fireplace Section 10B - Prefabricated 1. Materials Heatilator model 3036 open front or approved equal. DIVISION 15 - PLUMBING 1. Materials a. Following is a schedule of plumbing fixtures required for this job: ~aster bath Toilet - American Standard 2109. "Elongated Cadet" Lavatory - American Standard 3200. "circlyn" Bath - American Sts~dKrd Model 270 ~econd Bath Toilet - American Standard 210~ "Elongated cadet" Lavatory - American Standard 3200. "circlyn" Bath -American Standard Model 170 Kitchen sink - American Standard 5002. "F~stival" Fitting - "Aquarian II" 4200.028 b. Ail ceramic and fiberglass fixtures shall be white in color. DIVISION ].6 - ELECTRICAL 1. general Provide and install an electrical system, including all wiring, devices, breakers, switches, outlets, fixtures, etc., necessary for a complete installation, with all appliances, controls, water heater, etc. connected and ready for use. b. Coordinate with the work of other trades. Materials a. Fixtures, appliances, etc., and their locations are shown on drawings. All materials shall carry the LUL label. Wiring Non-Mettalic sheathed cable switches Slater, Specification Grade, silent toggle type, white Plates Slater, Specification Grade, plastic, white Receptacles Slater, Specification Grade, white D in, ne r Switches S15ter, RDCP series (600 watts & under) White cover plate, substitute white dial for ivory. Slater DAF series (Greater than 600 watts). White cover plate. Telephone Jacks Slater white cover plate Installation Install duplex receptacle outlets in all habitable rooms so that no point along the floor line of usable space is more than six feet from an outlet. Provide an additional receptacle between all doors and between doors and fireplace when separated sufficiently for placement of furniture. Except where otherwise shown on the drawings, the mounting height from the floor shall be for wall switches, 54 inches; wall receptacles, 12 inches; telephone outlets, 12 inches. Note: Please allow $1,000 for light fixtures. James Volney Righter A r c h i t c c t AD'DB.fq'~,oM To ~,?gd...IFlCATt0Mxo oS¢'AMCF&t,{-/d'q ..51'~NI2RfL.D ~ 1"'5':lo, ul-t F__rq-F~E."' t , 40'Chapel Street · New ] larch · (i, onncc {cut · tclcphoi:e · 2o:I 777-:}2:'2 . 0o FO~ NO. 1 TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ................. * praved .............................. ,9...7.. ermlt .... Disapproved a/c ......... .('. ............ .~ _.;~ .............. APPLIGATION FOR BUILDING PERMIT Application No....~....?f. .................. Date .............................................. , 1 ........... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 premises or public streets oF 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ........ State whett)~r,~lpplicont is owner, lesse~e~agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ......................................................................................... Name of owner of premises ...~..~.~:.~..'./...~.~..~...~......~~ ........................................................................ t~e of corporate officer) Builder's License No .......... /...~...f~ ............................. Plumber's License No ....... ..~..'~. .............................. Electrician's License No ................................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................... Lot No..3...~..i....(-~. ..... Street and Number ............................................................................................................ ------~-- .~-,.~,,,.,.~ ~./~,~,~.... ~j~/~,~/~_ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... b. Intended use and occupancy ...,~.~.~...-~,~. ...... .~2/~..t'..{~_.........~rr....~:~...~..~. x..¢.~...~J ................................. 3. Nature of work (check which applicable): New Building......~ ...... Addition .......... , ........ Alteratl'on ..... : .......... Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... (Description) 4. Estimated Cost ......... .~...~..~. ............................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... X. ............. Number of dwelling units on each floor ............................ if garage, number of cars ....... .~.~.~....~,,,~c... ............................................................................................................. 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 ....... ~:~ .................................................................................................... 9. Size of lot: Front ..... .~..~ .................................... Rear ..~...Z..~ .............. Depth ....~..~ ............. 10. Date of Purchase ........................................................ Name of Former Owner ..................................................... ~.. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~ ....................................... 13. Will lot be regraded ....~ .............. Will excess fill be removed from premises: (~Yes ( ) No 14. Name of Owner of premise~.~(.~....~.~. ...... Address ................................ Phone No ....................... Name of Architect~...;~l~.~¥__ .................. Address~...~ Phone No ....................... Name of Contractor ~i~...~.~...~ddress ~.~..~ ......... Phone No. ~..~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y 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,.YORK. [ c ¢ COUNTY OF ....~.C.).[.~.-.b.'..A,.~. ........ f-~.-~ · ~..~.~.~.,~.,~.;....~.........,~..~'.~..~t,~,~.,/./.. ................... being duly sworn, deposes and says that he is the applican, (Name of individual signing contract) above named. He is the ...... .~..~.~C~.~.~.~..~-~... ............................. .'.~.~..~...~...~......~.....~.~'~......~...~...~...~..!.~k.~...~.. ...................... (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 fo~h in the application filed therewith. Sworn to before me this ........ ............ ................... , ,Z Nota~ Public,. ................... ~.~'~.~.~.~' ..........Coun~ ~~~.~~ .................... ~MARY B. PANKIEWICZ