The URL can be used to link to this page

Home My WebLink About10440-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southo[d, N.Y. Certi[icate O[ Occupancy No. Z98~2 Date Janua .ry THIS CERTIFIES that the budding ................................................ Location of Property .... 5/Jt98.5..Mv3.~la .R~O.d S~.utho.ld,. N..Y, House No. ' ....... 'S'tle~{ .............. Hamlet County Tax Map No. 1000 Section ....~.2. ..... Block ....'1 ........... Lot ....... .~ ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..,eJe.-O~mbor'..5 ..... , 19 .?gpursuant to which Building Permit No ...... ']O./I..~.0Z ......... dated ..... Oo~be~..']2 ........... 197..9., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..................... Commer. cial .Office. Building ............................ The certificate is issued to ............. Klr'alllel:'. & J)ePe.~l?.i$ .......................... of the aforesaid building. Suffolk County Department of Health Approval . .8..-.65.....'l/fl.! ./.8.0....R.,..A.,..V.i.l.1..a ........ UNDERWRITERS CERTIFICATE NO ........ .~.../3'.6.'1.2.! ~ ................................ Building Inspector Rev 4~79 FOEM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PT~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NY 10~40 Z Permission is hereby granted to: ·. ..~_.0..,... ..... _F-~o~,~.~.~..~._...~ ............. to ........ ..(,,~/../~, ~..~../:.~ .0. ~. ~ · · · ~,~r.:~'/,~./~,~,~-'-~.,',~,,. · · .0/~. z. ~r-,~. · · · - · ~-~.~/~ .......... at prem,ses ,oeated ot ..~..~..'.--....~*....~.........~.~:..-....'..'.~.~..'?-..:.....-~.~..~.'~.~. ............. pursuant to application dated ............................................ 19Z. and approved by the Building Inspector. ~ee ,...,,C..O.....~:.. FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, 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. B. 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. 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 Date..,~.? .~.../../..../. ~.o~. ?. .... Building . ~..~.~. ....... Old or Pre-existing Building ............ Vacant Land ............. New Location of Property .................... /~d~/'/4 ~ 7-- ~.~ ?. ~. .~. ??. .~. . House No, Street Ham/et Owner or Owners of Property .. ~.~ .~:./,/,. ~. ¢..~d. .... / .j~ ..... ~_ /~¢~..~.~/...'~ ........................... County Tax Map No. 1000 Section O ~ .~.... Block ... / .......... Lot .... ,~.~ .......... Subdiwsion ................... Filed Map No ........... Lot No .............. Permit Date of Permit ?/.Applicant .... ................. Health Dept. Approval ./¢.P..~ ................... Labor Dept. Approval ........................ Underwriters Approval . ~..~'~;. .................. Planning Board Approval ...................... Request for Tempo rary Certificate ..................... Final Certificate ....................... Fee Submitted $...,~..,,~.. .................... Construction on above described building and pe~ee~ap~?le codes and regulations. /~.~ ~ Apphcant THE NEW YORK BOARD OF FiRE UNDERWRITERS BUREAU OF ELECTRI(~IT~ 85 JOHN STREET, NEW YORK, NE~W YORK 10038 ~ ~,:( !~.~'~-nc~ ~/s~.~ '~' ~.d~, 75~ w/o t,'i~e ~[ouse~ ~o~.~o.~. December ] 7, ! 9 ~ 9 and found to be in compliance with the requ,rements of this Board. FIXTURE OUTLETS J7 DRYERS ~ECEPTACLES 2~ SWITCHES FIXTURES RANGES OVENS EXHAUST FAN FLUORESCENT SYSTEMS NO. OF FEET C AWG OF HI LEG AWG OF NEUTRAL Th~s certificate must not be altered in any~manner; return to the off[ce of the Board may be I HENRYE RAYNOR, Jr,Cha~rman FREDERICK E GORDON JAMES WALL BENNETT ORLOWSKI, Jr GEORGE RITCHIE LATHAM, Jr, Southold, N.Y. 11971 December 17, 1979 TELEPHONE 765-1938 Mr. Edward Hindermann Building Inspector Town Hall Southold, New York 11971 Dear Mr. Hindermann: To date all work done at the premises of East End Insurance on Main Road, Southold, is in compliance with the approv~ site plan. Yours truly, HENRY E. RAYNOR, JR.; CHAIRMAN SOUTHOLD TOWN PLANNING BOARD Albert A. Sacco, R.A. SACCO & AHLERS Architects & Engineers 54655 Main Road Southold, L.l., N.Y. 11971 516-765-5455 Gordon K. Ahlers, P.E. October 16, 1979 Mr. Edward Hindermanh Building Department Town of Southold Main Road Southold, N. Y. 11971 RE: East End Properties Bldg., Main Road, Southold, N. Y. 11971 - Energy Conservation Dear Mr. Hindermann: E~ectrical energy use in this Proposed Building has been kept to a minimum. There is no air conditioning, radiation is individually thermostatically controlled, one small hot water under the sink unit and minimum lighting. Maximum use is 5 days per week. Energy Designs meet and surpass basic N. Y. State Energy Code requirements. Very truly yours, SACCO gz AHLERS Gordon K. Ahlers, P. E. Memorandum from.... BUILDING INSPECTOR'S OFFICE TOWN O1* SOUTItOLD TOWN H~,nL, Sou'moLr~, N. Y. 11971 765-1802 Permit Fee Ins. Fee $ Total Received $ 52.50__ Check or/Vi.O. No. hTo ]x~'umbez' k~ab hty Insurance Pohcy Expiring D,sabihty Benefit Coverage Pohcy Perm~ttee ~S~ A~ress BOX ~/~06 C~ty ~33~h~] rl State HIGHWAY WORK PERMIT STATE OF NEW YORK - DEPARTMENT OF TJ~ANSPORTATION SH No. 8229 Est. C0mpl. Date______ OB ~ (1979) ~PermitNo. ~l~:j~ -- 3 0 9 FD~ Zm 11971 Deposit Rec. far $. Check( or M.a.// Dated or $ 1,000 ChargeabJ~ to Bond # 686876-Indef. or Undertaking on F,le Workmen' s Compensahon ' Pohey # Expiring Under the urowsmns of the Highway Lawpermlss~on ,s hereby granted;(o~e permitlee;;to o~e~ the n/sr o£ Main Rd. (~te. 25) approx. 500' e/o You~gs ~e;~;$C~HOL~ ~o install one 25' curb cut, concrete apron~ concrete sideValk~ ~tle~nal draina~e~ cham~elizatio~ in the county of ~'d£.~O~Ll, C as s~t forth and represented ~n the attached ap~plicahon, cfi' the particular Iocahon or area, or over the routes as stated there~rt, If reqmred; and pursuant to the cond.t ohs and regul~hons, whether general or special, and methods of perform,nD work, i~ any; all of wh,ch are set forth imthe bp~jication and~f~ part of this permit. Dated at Ita~npa~e , N.Y. ~o~e~~X ERM T. WITH APPLICATION AND DRA~ING (OR C~P,~ES THERE;~TA~s"~ ... BE PLACED IN THE HANDS OF THE CONTRACTOR .BEFpR~ ANY WORK IS STARTED. ~ NOTICE - It is absolutely necessary that the ~rm~ttee notlfy, ~. 'R~ ~hyberg~ ]'TYS DO~ ~e~ ,~t Engineer, whose address is ~e~. ~e~. ff~t.: Ha~]~m]~]e~ ~ Tel. No. ~g~ ~ before work is started and upon ~ts completion. ' [ TOWN OF SOUTHOLD OFFICE OF BUILDING ENSPECTOR TOWN HALL SOUTHOLD, iN'. Y. 11971 TEL. 765-1802 May 24, 1979 Suffolk Couuty Department of Health Services County Center Riverhead, New York 11901 Attn: General Engineering Service Re: Wayne DePetris d/b/a East End Insurance 54985 Main Road Southold, New York County Tax Map Number 1000-62-1-'+5 Gentlemen: Wayne DePetris has received approval from the Southold Zoning Board of Appeals and Planning Board to divide property with insufficient area and width and for permission to construct a build- ing with insufficient side yards. xc: Sacco/Ahlers GHF/pjs ruly, Sr. Building Inspector CONSTRUC'PIOq f~P{~CIF[CATIO,tS FOR [[IG!IWAY ~,,7011K PE['~qITS e lO. tlighway pay,meat il; not to be opened unless authorized on front sheet (perm 42b) of tlc. is Permit. Sleeves shall be jacked unde. r the highway for all highway crossings, unless permission to cross in any other manner is given in writing by this office; and jackin['~ and receiving pits must be kept a min. of 5' from the edge of pavement. As a general rule, the "open cut" method for crossin~ a h~ghway will not be permitted; the need for any such open cut must be substantiated by the permittee and permission granted from this office on the b~sis of satisfactory sheeting, maintenance and protection of traffic, compaction e~uipment, etCo Any excavation Jn excess of 5' fn depth must be sheeted in accordance with Code Rule 2$ and OSHA. Any excavation closer than 5' to the edge of pavement must be sheeted as directed by this office. Ail backfill must be compacted in a manner satisfactory to this office. Adequate signs, barricades and li~-hts, in accordance ~ith the standards of the N.Y.S. Traffic Co~n. Manual of Uniform Traffic Control Devices, Subchapter G, shall be provided. Barricades, whether in sidewalk or roadway area, shall have prominently displayed, for police convenience, the address and telephone number of 2~ hour availabilit~ of someone who can reset the lights and barricades i~' i~ should become necessary. Pedestrian and vehicular traffic is to be maintained and protected at s].l times. There shall be no unprotected Or unlighted drop-offs or ob- stacles. No pavement openings will be permitted to remain open over night, they must be backfilled or plated at the end of the work day. Open holes outside of the pavement shall be fenced or g~arded. The permittee agrees to pay all costs incurred by the State, including man- hours and equipment use, necessary to correct any unsafe conditions on a ~ermit site. In the event that the permittee has permission from this office to open the pavement, only one lane at a time may be opened provided safe two- way traffic is maintained at ell times, with adequate signs and barri- cades to warn the public whenever work is performed on the highway. As stated above, no pavement area may be left open over night or on weekends. Adequate access to adjacent properties must be provided. Pavement and Paved Shoulders - Minimize size replacements in finished concrete or asphalt on concrete base shall be 10' x width of panel. In all cases, if the replacement is within five feet of a joint, or five feet of a major crack, the replacement must extend to the joint or crack. Any opening in concrete pavement shall be saw cut ~nd final re- storation must be done with Hi~h Early Class F concrete mix. In the case of an opening in asphalt, the minimum size replacement shall be a' x 4' or at least 18 inch cut back beyond the size of the hole. Asphalt restoration shall be made by cutting, with a wheel or jack-hammer the existing adjacent osphalt s~uare, painting the exposed face with hot AC, placing the new asphalt, and compacting with a ten ton roller. Surface variations in excess of 1/4" shall be eliminated or the pavement relaid. Unless otherwise directed by this office, asphalt shoulder restoration shall be ~" Item ~05 (P 1/2" Binder and i 1/2" Top) on a sound base. Sidewalk where disturbed, shall be replaced to full panels of a minimum size 4' x 4' or as marked when found. Concrete curb where worked on, as in the case of the installation of a new curb cut in an area of existing full curb, or v~ce versa, shall be removed to its full depth and replaceo in accordance with Typtcal Sections from this office. Cold Patch - A minimum depth of 2 inches of asphalt concrete, whether cold patch or hot asphalt is used, shall be placed as a temporary surface in any pavement, shoulder, or sidewalk opening that must be restored to use prior to pe£manant restoration. Where temporary asphalt is reouired, the ed?'es shall be cut s~uare and the temporary asphalt placed on a well stabilized base. ]t ia the permittee's responsibility to maintain any temporary patches in a safe and useable condition. ( eve r ) -2- 11. Drainage - There shall be no contribution to; nor interference with, drainage along the iState Hi~hw~ty, either during the permit work or after ss a result ~f such work. Drainage along hig'hw~y is not to be obstructed. Profile of drivew~,ys and the cross-section of the finished shoulder shall be such as to follow the drainage cross-section of the highway shoulder. IInitial slopes shall be away from p'gvement of highway. Finished driveways iwhich block, or otherwise interfere 'with the normal flow of drainage, shall be removed ~nd replaced by the permittee to the proper F~rade, or, {f permitted ~n writing, the permittee shall construct the necessary leschin[~, b~sin to relieve the adverse condition, all to the specificationslof this office. 12. No trees within th~ State rig, bt-of-way may be cut or trimmed, eithe~ above or below g. ro~nd, without permission in writin~ from this office. The Landscape Department of this office will be given 72 hours notice and a joint inspection ~rran~d, if the work in ~ny w~y jepordizes the trees. The permittee a~rees, by ~cceptance of this permit, to replace any trees damaged without permission of this office. As general rule, trees will NOT be permitted to be planted in the grass area between curb and sidewalk. , 1~. The permittee shal$ ~eep the traveled way free of foreign objects, such as'rocks, timbers,i~nd other items that may fall from transporting vehicles. Spillage of material carried by, or dropped from the under- carriage of any carrying vehicle resulting from the permittee's hauling operation along orlacross the public traveled way shall be removed imme- diately and such traveled way, shall thereafter be maintained free of such spillage. ~ l~. All materials must!come from State approved and inspected sources. All concrete delivered;by transit mix must be shipped in an approved carrier. Asphalt concrete must be within specification temperatures and the load properly covered w%th a canvas. 15. No official State Traffic Comm. signs may be disturbed without approval from the Permit De9artment. If it is necessary to relocate such signs, the Regional Traffic Department must be contacted for the new location, 16. In State Contract ~reas bhe permittee must conduct his work in conformity with the schedule ~f the State's Engineer-in-Charge and contractor, and all work must be d~ne to the s~tisfaction of the State Engineer-in-Charge. 17. The permittee shal~ furnish this office with a telephone number of 2~ hour availability,lwhere a demand for emergency repairs will be immediatel honored. Furthermore, the permittee agrees to assume all responsibility for emergency repairs which are m~de, whether the need arises as a result of his contractor'S work or by storm damage done to his contractor's work or by any other means which renders his contractor's work area uusafe in the opinion of thiD Department or the Police Department. In the event that it becomes necessary to call out State Mointenance forces to restore a permit site to ~i safe condition, the permittee will be back-charged for all manpower and ebuipment chard'es involved. 18. All ~ork to be don~ in accordance uith N.¥.S.D.O.T. specifications. January 2, 1979 PERM 33c (12/70) Application is hereby made for a hlghway work permit ~ox 1~ STATE OF NEW YORK - DEPARTMENT OF TRANSPORTATION HIGHWAY WORK PERMIT APPLICATIOix+I' PaR NON-UTILITY WORK Highway Permit No, E ffecflve Date 11971 ]. Requested duration from _19 2. Protechve Liabihty Insurance covered by policy No. 3- Workmen's Compensation Insurance Pohcy No. 4. Disability Benefits Coverage Policy No. f'ENTER NAME AND MAILING ADDRESS IN THIS SPACE thru 19 expiring PREPARE 3 COPieS BOltD: $1,000 NO. 686876 Indef o , to apply to the operahon(s) checked below.. expires on 19 Check Type Permit Show Ins,Fee In Total Amount Guarantee of Operation Pee Amt. or PERM- of Fee and/ Deposit Amount 17 pr Under- or Insurance and/or Bond taking on hie [~4. Single lob . Permit issued for each ~ja. Driveway or roadway [~ Private NC [] SubdJYJslon Street $100 J~] Pti va te NC ~-~. M i--s ce I-~a n~ou s---C on'ir u'~ ti o-/' ........................... .... ~[~]~Demo__.J,t, o~n -- ~ Mo~vi n~g ............. N C TOTAL PAID $52.,50 Workmaybed ..... bedbrieflyasfoHows~O open the n~s of Matn Read (Rte. 25) approx. 500' e/o Youngs Avenue, BOU~D to ins~l] one 25' ~ eut~ ~ ~p~n~; concrete si~ewal~, internal d~ainage, chan~eltzatio~ e~e. [] Additional work description is attached; [] Plans pages and/or__ [] Map is flied showing work to be performed at; LOCATIO" (~ ~ ~ Sta. Migh. w. ay N_o,..82~ between station and statmon in the Town of,'~tOnl~no£¢ Cou.ty o¢ 8uffolk and obligahons stated,on this opphcat,on and on the permit, PERM 32 & ~3 (12/70) REVERSE RESPONSI'BILITIES OF PERMITTEE PJ~OTECTIVE LIABILITY ~INSURANCE COVERAGE . Permittee must have protecilve liability insurance coverage in accordance with Department requirements. (See Infor- mation on Protec'hve LJabdlty Insurance Required for Highway Work Permits and/or Special Hauling Permits, Form PERM- 27). Expiration of, or lack of, liability insurance automatically terminates fha permit. Insurance coverage may be provided by furnlshlng the Department with one of the following: a A Certff,cate of Protective Liability Insurance for Permits on State Highways (Form PERM 17, NYSDoT) b. A $2.50 remittance (che~k drawn on a New York State Bank or Certified) for coverage under the Departmental Blanket Policy. c. An Undertaking may be f~urnished by Public Service Corporations and Government Units only and must include the wording required by the ?apartment. COMPENSATION INSURANCE AND DISABILITY COVERAGE The applicant is reqmred t~ have compensation insurance and disability coverage as noted inthe provisions of the Workmen's Compensation Lawand Acts amendatorythereof for the entire period of the permit, or the permitis invalid. NOTIFICATIONS Notify Commissioner, through Regional Office, one week prior to commencing work, except emergency work by public service utilities which should be reported the next work day. Work must start within 30 d~ys from date of permit. Nobly area,gas distributors 72 hours prior to any blasting. Notify Utihty Companies with facilffles m work area (permission must be obtained before doing work affecting utilities' facilities) before starting work. Notify land owners of abutting lands, before disturbing trees. Notify Department of TranSportation at conclusion of work and return ong~nal copy of permtt to Regional Office. Annual Maintenance Permit Notifications: Notify by telephone the DJ~tnct or Resident Office, one week In advance, each time regular maintenance work is to be performed. In emergenmes, notification by telephone should be made the next work day. SITE CARE AND RESTORATION An Undertaking, a bond er ~ertifled check in an amount designated by the DepartmentofTransportation may bereqmred bytheRegional Office, befor'e a permit ~s issued, to guarantee restoration of the site to its original condition. If the Department Isobhgedtorestoretheslteof~tsorlgmalcondmon, thecost to the Department will be deducted from the amount of the permitteels guarantee deposit at the conclusion of the work. The permittee is responsibl'e for traffic protection and maintenance, including adequate use of signs and barriers during work and evening hours. No unnecessary obstruction is to be left on the pavement or the right of way or in such a position as to block warning s~gns during or between wokk hours. No work shall be done to obstruct drainage or divert creeks~ water courses or sluices onto the right of way. All falsework must be removed and all excavations must be filled ~n and restored to the satisfaction of the Regional Traffic Engineer. COSTS INCURRED BY ISSUANCE OF THIS PERMIT All costs beyond the limits[ of the protective liability insurance, surety deposits, etc., are the responsibdity of the permittee. The State shall be held fre~ of any costs incurred by the issuance of this permih direct or indirect. SUBMITTING WORK PLANS The applicant will submit work plans and/or a map as required by the Department. This shall include such details as measurements of dnveway~ with relation to nearest corner, positions of guys supporting poles and a schedule of the number of poles and feet of excavation necessary for completion of the work on the State right of way. A description of the proposed method of ¢:onstruction will be included. Plan work with future adjustments in mind, as any relocation, replacement or removal of the installation authorized by this permit and made necessary by future highway maintenance! reconstruction or new construction, will be the respon- sibility of the permittee, j The permittee must coordinate his work with any state construction being conducted. TRAFFIC MAINTENANCE, Traffic shall be maJntamea by the permlttee on the highway, in a safe manner, during work and evening hours until its final completion. Suitable bafeguards, to reduce conditions dangerous to life, limb and property to a minimum, must be provided by the permlttee (including flagmen when requested by the Department). COST OF INSPECTION AND SUPERVISION If, in the accounts kept bylthe Department, costs of supervision are found to be exceedingly high, the Department re- serves the right to bill the] permlttee for actual expenses recurred by the supervision and inspection of the permlttee's prolect. J · SCOPE J a. ~,reas Covered j Permits issued are far .h~ghways, bridges and ~ulverts 'over which the New York State Department of Transportahon has jurisdichon. (Locgl governments issue permits for their own jurisdiction.) b. Legal The privilege granted by the permit does not authorize any infringement of federal, state or local laws or regulations, is limited to the exten~ of the authority of tbs Department in the premises and is transferable and assignable only with the written consent of the Commissioner of Transportahon, c, Commissioner's Reservations TheComm~ssioner of Tiansportatian reserves the right to modify fees and to revoke or annul the permit at any time, at his discretion withmJt a hearing or the necessity of showing cause. d. Locations ' ~?ork locations must m~et apj~roval of the Department. (Additional 'p6g~s t~ th s?~pp!iqation vary according to the pui'~pose and type of work to be~grm[tted) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined .Q-O...~77../. Approved .~..~-.77.. Disapproved a/c APPLICATION FOR BUILDING PERMIT Application No./.O. ~...~..~). ...... Date ................ 1 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and stibmitted 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by th~s 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. x. .............. (Signature of applicant, o7 name, if a corporation) . (Mailing a.d~!res~ of app!ic~a, nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .C.('~.~.5. ~;/~.'.b~. ~.~.~ P¢~. 'J.-~.~-.~. ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No.. ~.~"~--r..'~'.C~ ......... ' Electrician's License No...~.O..~.. ~..~.MT~.~.~.. Other Trade's License No ...................... 1. Location of land on which proposed work will be done.'~ ~' \¢~ ---.~-:~.'.:.., .... -....-3W~.. ·I .... : ...... , L ................................................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~Q.~ ..... Block .......... [ ....... Lot Subdivision .................................... Filed Map No ............... Lot ............... (Name) 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. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVal .............. Demolition .............. Other Work ............... p'T7~Ii '-'~2~--O ~ (Description) 4. Estimated Cost .... t"[7.0.[. ..... ........................ Fee .................................... : (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 ..... ~ ................................................... ~,~ ............ If business commercial or mixed!occupancy, specify patgre and extent of ea,ch~tzpe of use .... .c~..-~..-~. '_,~ .~.. ....... 6. Dimensions of existing structures~, if any: Front .... ' .,[~..d.~. ....Rear .. (fl~...{,~k~ ....... Depth.../[:~I-. ........... 7. Height ............... Number of Stories ........................................................~'_Trzx Dimensions of same structure wiih alterations or additions: Front ................. Rear .................. Depth .................... i ' Height ...................... Number 9.JSStories ....... 8. Dimensions of entire new construction: Front., .~..~. ........ Rear...~.~ ........ ip'th'. ii . Height ............... .~mber of Stories ............ ~,~ .......................................... 9. Size of lot: Front ...... .~ ./).. i .......... Rear ...... .&..O ............ ~,Depth : .... J.,,.q~-qDt, ........... 10. Date of Purchase ........... i ................. Name of Former Owner . .%~. ~e~...~..~.x~.~\%r~..~ .... 11. Zone or use district in which premises are situated...~> .~ .~ ............................................. 12. Does proposed construction vi.ol~te any zoning law, ordinance or regulation: .... .~..O. .............. ~ ...... 13. Will lot be regraded ...... IQ.. [ .................. Will ex, tess fill be removed from premises: ~ No 14. Name of Owner of premises .~6....~..~?..~q.~..~...~... Address ~:~., ~.%~.~q.~. ~?.%-rg~.. Phone No..'3.~:~-~-~.(~\1 ...... Name of Architect . OB;ef,~ :e...~,~)'4h~. ........... Address YY[~k¢?3..~.. '.~..~qcT/-~.l.dPhone No ................ Name of Contractor ...<)..e.~-.4~ [ ................ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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/~ORK, t/ ,~ ~' .~ o COUNTY OFt.~~~ ~'~t~'~-~, '' ' ....... ff~. ~o~...(-~..., ~ ....... being duly sworn, deposes and says that he is tho applicant (N~e of individual sign~n8 contract~ above named. . . ~ He is the ~-~e~..'. ' ,...I (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 mann6r set forth in the application filed therewith. Sworn to before me this ....... .......... ..... Notary Public, . ............... ; ~. County .... · ..... .......... /~ ~f~fLf~ffl ~L~ork - / ' ' ~ignature of applicant) Te~ ~pir~ March ~,