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HomeMy WebLinkAbout10644-z I ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-23735 Date JUNE 27, 1995 THIS CERTIFIES that the building 1IDDITIONS Location of Property 1600 (a/k/a 1490) SAGE BLVD. GREENPORT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 53 Block 5 Lot 11.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 22, 1980 pursuant to which Building Permit No. 10644-Z dated APRIL 30, 1980 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 1IDDITION & 8'x16' DECK 1IDDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR " The certificate ia issued to JOSEPH & MARIE KNIZAK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-483506 - JUNE 23, 1980 PLUMBERS CERTIFICATION DATED NIA "NOTE: THIS UPDATES CO Z-13812 Rev. 1/81 ~ j ,g z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall South old, N.Y. Certificate of Occupancy Z13812 September 3 85 No. ... ...... ... ..... Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 19 . . . THIS CERTIFIES that the building. . . . .addition .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 1600 Sage Blvd. Greenport LocatIOn of Property ............................................................... House No. Street. Hamlet County Tax Map No. 1000 Section ..... 5.3. . . . .Block ..........5.... .Lot . . . . . ~~. . . . . . . . . . Subdivision. . . . . . . . . . .:;c. . . . . . . . . . . . . . . . . . .Filed Map No. ... ~.. . .Lot No. ...... ~. . . . . . confonns substantially to the Application for Building Pennit heretofore filed in this office dated .... .1}Ji:r;l.1. .;;;;;!. ., .. .., 19 .~Qpursuant to which Building Pennit No. ... ~~~~~~.... ... .... dated. . . ./1.:p'J;":\.:).. 3.Q. ...... .. ......19 !3.Q , 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 . . . . . . . . . . . AdcJ.:i.ti.Q:Q.. t;P. .OJ . (iJN.e.U;ip.g, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . The certificate is issued to ........... iT.Q9~ffl .IS: . flA.~~ . . . . . . . . . . . . . . . . . . . . . (owner. af the aforesaid building. Suffolk County Department of Health Approval ........... :rIA. . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . ;N:4;E?3.5P.E!. . . . . .. . . . . . . . .. . . . . . . . . .. . ....... .4)#5. .~'.................. Building Inspector Rev. 1/81 ; . ..1. ,Jl ~ ~^ FORIII NO. 2 TOWN OF SOUTHOLI> BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLI>, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10644 Z 0.1.1 3 cJ gv Date ................. ........., ........,.................., 19........ Permission is hereby gran~: ~'f k II~ n '>' ~ rf." <. ........'/............................................ ..' .... .. ,..,.......... % 9. ~ V ~. h - (1""cf~ O"'U-t' 1 ./"Yl.t. ",a - .........:'2....... .......:.........,..........J.............. .."...... . (Iq 7/ ....../-:<?~.?.......?:.'.::':~..':::~........4:.{.. .4:./4I'd It,; ~(j;;., ( & /I {f! t -t ,-,.-. 5t1. ,6: ,df.;.w.1 t,~" r; to ....................................................."........, ./.. ,.............,......,.................................,.......,........,.......,. ............:..................................../i.(.,.o.........;;:,;.;. ,......~B4~:....0.......................................,...,..., . at premises located at .............................~......,........... ..............................................,.........,...,.. ......................................... ............................ .......:: 'J:.: .~........!. !..t;... .'................................................,... d . k )1 ,.tJ.~ ( (1 00 ,-- / / A'I1-'T, (':\ I.-:'/.'" - :.J 3 - !J - ............................................................................................................................................................ ,. pursuant to application dated ............................,...9.:....:~.~.., 19~?., and approved by the Building Inspector. tJr/ /5- Fee $........................ ~ ;7/~ ................................................................................ Building Inspector , . l'orm No. r, , c \, \' : {I" ,: :1 'c 10llN OF SOUl'IIOLD BUILDING IJCPARIfIENr JUN ? 2 1995 TOliN "A L L 765-IB02 APPLf.CA1ION FOI( CmTIF!CATI: OF OCCUPANCY ,\ . TilLs application must be filled in by typewriter OR illk aTld submitted to lbe bn ilding inspector '.Jith lba fallot/lng: [or 11('\" oUjlding or tlC\" use: l. F'in<:tJ survey of pr-operty Hith nccurnlc locnlion o( all buildings, property lines, sl,:eels, and Ullll:;ual Tl<Tlural or topographic features. 2. final ^pploval from ''''ollb Dept.. of ,,,ater supply and s('\.}crage-disposal (5-9 [arm) . 3. Approval o[ eleclricm1 installalion from lloard or Fire Underwriters. I,. SworT1 statemeTlt fro,n'pJu,ubct certifying tlTat LIle solder used itl system COfltail-S less tban 2/!0 of 1% lead. 5. Commerdal bUildin~, induslrial bUilding, multiple residences and simiJar buildings and installatiQns, a certificate of Code Compliance from architect or engineer lesponsJbl. for tb. building. 6. Submit Planning Board Approval of completed site plan :requirements. B. for existing buildings (prior to April 9, 1957) non-conforming uses, or buildjt1gs and "pre-existing" land uses: 1. Accurate survey of property sflowing all property liTles, streets, building and llllllsual Ilatural or topograpllic fealures. 2. A properly completed apptication and a consent La inspect signed by the appl icanL. I [ a CCl tiC lea t:e oC Occupancy is denied, the Building Inspector shaH stale lhe redsollS tllere[or il1 wrilillg to the applicant. C. Fees r. Cerlificale of Occupancy - New dwelJing $25.00, Addilions to dwelling $25.00, ^lleratjons to dweJling $25.00, S'''imming pool '25.00, Accessory buildIng $25.00, Additions to accessory bUilding $25.00. Businegses $50.00. 2. CertificaLe of OccuI,atlcy on Pre-existing BuiJding _ $100.00 3. Copy of Cerlificale of Occupancy _ $20.00 I, . Updated Certificate of Occupancy _ '50.00 5. Tplllporary Certificate of OccupaTlcy - Residential $15.00. COJmnercial $15.00 Date ........................ ................. .~ C t. t. . Old 0 P '. . B 'ld' Q. \!-<,.d........&. .kd" (t' ~ Ib') 6.-,. ~'-'I \+. ,ew ons ruc 10n........... r re-eX1stU1~lng................. Location of Property.... .!I... '~1q. .~j~...... .\~~~.. .... .... .~~~~........ llouse No. Street llamlet O"',er or Owners ,..f Property.... .~s..<;?~\... .J.;. ~"r~~. k~~ ~~~..................... Coullty Tax HalJ No 1000, . ~~ S- /I d--. Sect10n............. .Block............... .Lot...... ................. SubdivIsion................................... .Filed ~1"p........... .Lot...................... :'e tmi t. No.......... . . . . . . DQ t.. 0 [ I' e rlJ1i t . . . . . . . . . . . . . . . . App lie .In t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 'Ieallh Dept. ^pp roval . . . . . . . . . . . . . . . . . . . . . . . . . . Untie r\.Jr i t e r s ^rp roval . . . . . . . . . . . . . . . .. . . . . . . . . . Jlannlng Board ^pproval........................... {equcst for:: TClHpor.lry Certificate.......... .1.':f,~ticDt.. ce SUbtni.~:tcd: $. . S O.,.f/.TJ. . . . . . . . . . . . . . . . . . . . .............., '" tr"" -_..._~ CO.:t....23J35 i ~ . C' '[9< "'J1 J.- t;'''' Jy S0,Jo. ~.t ,,,-r2D r ""I fORM NO.6 . 72< ~S <'ke'4 ~ TOWN OF SOUTHOLD Jr1t:>Y1r Building Department .s- fl:J?! G-t=E= I) (( I V t:. Town Hall Sauthold,N.Y.11971 .sn"JY bQ.oolC N,y APPLICATION FOR CERTIFICATE OF OCCUPANCY II 77'0 Instructions A. This applicatian 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 af 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 farm 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 far the building. 5. Submit Planning Board,approval af completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-confarming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines. streets, buildings and unusual natural or topograph ic featu res. 2. Sworn statement of owner or previous owner as to use, accupancy and candition of buildin9s. 3. Date of any housing code or safety inspectian of buildings or premises, or other pertinent infarma- 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 accupancy $1.00 Date. (:'(4.r:-. .4..t. '7.&:1. .. .... .. . New Building .... . . . . ',' . . . Old or Pre-existing Building ............ Vacant Land ............. I 00 Location of Property 7:'f14. fllc;;-!,::;)?~~J';>.. .. . .... ... ....... .. 0f1:t;t?~ f.o.~r.. .. .. .. ... .. House No. Street Hamlet Owner or Owners of Property . .;J;;,.5.1:';1?f:f. .1-: .il:-1o;\.'~(~ . (<^I! '!:I)/<. . . .. . . . . . . . . . . . . . . . . . . . . . ,,-"J :F If County Tax Map No. 1000 Section .L..:........... Black.. ............ Lot................ Subdivision. , . . , , . .. . . . . . . . . . , .. . . . .. , . .,.. .Filed Map ~~',\j~; 'C.',l.EEi< 'i;,:~1NEO;' ~;..;c."""'" PermitNo.1.t!~. i.f'fZ-. DateafPermit tflZ':'!~?'.APPlicant'.. .tJ.o.t?f..~T. .l}~'.<~'!'.Iff-:.............. Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Labar Dept. Appraval ........................ U d . A I N L/'iJ 3!:rc I" . n erwnters pprova ....................... .Plannlng Board Approval ..... 7 . . . . . . . . . . . . . Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . . . , . . . . . . . .. . . . . . . . . . F<"'iS *DD ~ ~ Fee Submitted $ .0. . . . . . . . . . . . . . . . . . . . . . . . . . t.t,*d~ ig 1/';):" d.ocdb<d b,'Id'" 'l~" mhi ~P"'"'' 00'" '"' _''''0", ~.~, ~7&>;;J Applicant. .. '~Jf2;~""""""""""""""'" Rev. 10-10-78 , ., " L.j, ,_:It L, , .._~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY far 85 JOHN STREET, NEW YORK, NEW Y9RK 10038 JU!1d 2" 19,:1\1 075228 Date ..:>, Application No. on file N 4 ~0 !:o;:"c: THIS CERTIFIES THAT 0,,,,..,\'0 only the electrical equipment as described below and introduced by the applicant named on the abo~e application number in the premises of Jo"eph ~'l'o""Jk w/s Sa~e Blvd. ,2000' s/oNdn Rd..Southold,N.Y. ,...., ..... i;'~ ~., , in the following location; D Basement qtlstFl, o 2nd Fl, oUtside Section Block Lot was examtned on JU~le L9J 1980 and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COO~ING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCENT FLUORESCENT MERClJRY toMT KW AMt KW AMT KW AMT KW AMT H P VAPOR L 0 1. 2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME C~OCKS BELL UNIT HEATERS MUL TI.OUTLET DIMMERS TRANS. SYSTEMS I AMT KW OIL H P GAS HP AMT NO AWG AMT AMP AMT AMPS AMT H P NO. OF FEET AMT WATTS I 1 Ii' I SERVICE DISCONNECT NO OF S E R ,V I C E METER NO OF CC COND AWG AWG AMT AMP TYPE EQUIP. 1,R2W ljif3W 3H3W 3jif4W NO OF HI-LEG NO OF NEUTRAlS AWG PERH OF CC COND OF Hf.LEG OF NEUTRAL OTHER APPARATUS #""'-~-~'~--'..." - " /" ,.~ U.f/? h r~ I /. nul art" E) ~.::,,~ , Co. w V;, '1 P.O. 110k lLf ) Hl.lttil:uek,H, :r:, J l~} f,)z L~c.242 GENE~ NAGER / , ?< / p" ThIs certifIcate must not be altered in any manner; return to the office of the Boord if ipco; ect. Inspector~ may be identified by th:i\ crede ''', tia~.,. COpy J:OR B~ILDING DEPAR1ME~T. THI.SCOPY Or ;~~iTlf;!~t3~ lJ,~9,T,/lli~LJ~~F~ IN ANY MANNa... /' STATE OF NEW YORK) COUNTY OF SUFFOLK)ss.: JOSEPH KNIZAK, being duly sworn, deposes and says: L That in March, 1980, my wife and I purchased certain permises commonly known as 1490 Sage Boulevard, Southold, New York. 2. ShortlY thereafter, we contracted with Long Creek Homes, Inc. to build a sunporch and deck addition to the house. That the contractor agreed to obtain all necessary permits for the construction of said sunporch and deck addition. 3. That in April, 1980, a building permit was issued for an addition to our house under No. 10644Z. That the sunporch and deck addition were completed by the contractor and on September 3, 1985 a Certificate of Occupancy No. Z13812 was issued for an addition to a dwelling. 4. That at all times until the present, I believed that this Certificate of Occupancy for the addition covered both the sunporch and the 8' x 16' deck additions. 5. That it has just come to my attention that said Certificate of Occupancy did not include the said deck addition, which was built at the same time as the sunporch addition. 6. That request is hereby made to reissue said Certificate of Occupancy to include both the sunporch addition and the deck addition to said dwelling. - N McLAUGHUN c State of New York Qualified In Albany County My CommISSion Exp"" ~m ~ i , o ",do , ~_.----_._- .J ,~~~_ ~~~ ;'0 c;:~ ? E ~2: ~.'~.1 ~_ ~ ~.. Jt) ~. ., . .._ _" _ _ " _ _ _ ~ ---. __~~_-~__ ---'~~=~~=~~==~~'==~~7-- --~~ 1m ;=L~LQ--L!..':L:;;:' P_E;c up I~J f)h[i;: L______C 0 I'-/L_'~C:: ,,,; I_~__.___' ---, -- - \7:1...... -------.-,----- 'I ' ------.---------.---.--..--.--~~=~- . '"t <:::> Ii . -"II' li ! -- r 'F,c,,-,,-, o All 0 1'-' 10: II II - <- /, r/ ~.: ~ ~~ .'~_ .1" '1'. ~ I I. ------- ! Ii €:"!!... I ' x..:..p- . >>\ [ C1 .. Z t:!E. ' -It;! I --- - -- --... 2 I ; , ?-(S' ~ot.:J (; H F1CAlv\~ ,6".-J-Ir5P't1/ r ~ 1# 0", i~1- ~~ 'i ?L u fVll=3 I N G, I Ii c:?' It\. . ~~ " ~~ I 1 I ~ 3 II Ii \l. 1\"-1 SULATJ 0 t--:I I ! <,'-" A- I~ .J......,. T' S -r J c.: J EN <=.rz.e>. Y Co D:=' l_ : .---' ~~ = ..,_ _ . _ _ . ._ ..-Ji =L . _ . JI' , f '1- L_~m~ ~-~~-----_.- - I ---~-- -' ' , t-/I\.../AL '! !~/$t: VK~" <:,6. we ----. '=t ' J ! I ! : :_____. '_ _.. .._u___ _"__' _'"'''' h., . .---~~ -- - _.~~=-- ADD / T I d tV ALe 0 "-/\ 1\/\ ~ 1\.1/ 5 ~N )> ___,_. _.__ . .. .... ,----. it .. . ~ . . - o ....... ,... ,cVJ vO _ - ;:1_ "\\$ ~ -- -------_._-~-~---_. 1 ~~._---- ------~----~------- __.__. _..._____. .___.,..__ __"._,..___________________.~==___.l- --~---- , ' . I ,{ '. ",L.. " ....., - "'--. . , I }-'1; ~ TEL. 765-1802 TOWN OF SOUTHOLD OFFICE OF I3UILDlt'\G INSPECTOR r.O BOX 728 TO\VJ\ H,\LL SOUTHOLD. N.Y. J 1971 6~:r~~~.~ - Applicant Q)~,,,,,,,-~- N "^" , \ , De"r\'~ \<; ~~ ,\-~ ,'",,"'4 : .This is to adv::'se you c.h~ th,e job u~er Build::.ng Perm::.t No. jo\,lllf' ::.ssued to ,^O'y'1 0"-'->1J.. ~~ on '-\\~O\'iI() for Q&,~"" .::'S CO[;]p2.e ea and a [1.:1a1 .l.ns;JE.ctio:J. t'J2S / / uas nO:'Q D8en aone. In oreer to co:;]plete this file, ::.t is necessary :.-:a t a Ce!"'tl.f.l.ca'te of O;:Cu;J2.ncy be .:.ssued. Please f::.11 out :':1e €f.!closed fcrm(s), return S2.::Je to the a80ve O:.'-'i'lce w':i:h a check for $5.00 paya~le to r.:~e Town of Soutr.old. Please ir..c.lcate to whom the Certlfl.cate of Occupancy is to be !"':2.:1ec, and arrange wlth this offlce for an .lDspect:ion date. Thank you for your prompt attention. Very truly YDl1rS, Y:.cL --.--P ! q 'L v C'.-') ("'"-1... t-- Victor Lessard , Adm.lnis-vr'c1tor f!~ VL:ec ErlClcsures - 'j;;J.l it t:i i , 1,,,,,, I FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined...... ,f)r-:J.~ 19?# Application No. /.q.~.:: Y...... Approved. . . . . .~. . ~~., 1iJ). Permit No. / P ~ .~'!. L- -- Disapproved a/c. . ,. .. . , . . . . J' '. .. . . .. . . .. .,...., ......................,..........,... ..~ ~.... ~ ~~ ~ ....,..~t1.~.~ (Building Inspector) APPLICATION FOR BUILDING PERMIT 0 L.( '2 t- 51J Date. . . . . . . . . .. ......, 19 . . . INSTRUCTIONS a. 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 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 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 Oecupancy 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 ~cti00 4., , _ ~~ ,A.<RL ffm::7 Ji)J( (Signatlr'e oZlicant, or name, if:;fcor ration) . . . /?..~ F . . . ":":-:'~":..;-:~ 0:1<: .. . 'f<!!~~/:'. (Mailing address of appli nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~~'e'~;~~~~~~~~'r~~'i~e's' :gw~~';"/~Z~~~~n:the:tax:r~llo~l~t~~tdeed):::::::::::::::::::::::: If apPlican~ra y"orati~n~e of duly authorized officer. ~~.(T'C/. /~t<.__ ....... .........,......... .;1-/,............... (Name and title of corporate officer) Builder's License No. "............"",...... Plumber's License No. ,......",...........". Electrician's License No, ...,.,..".,.......... Other Trade's License No. .......,...,......... ~ L r.".oo of .0' '0 .hi,h ,ro,ow' .o<k w;U ho "00. ..... ~"'. .~~667 .. . . . . . ... . . . . . . B' t;). Co). .. ~(",'I:/r . P.' ~ .104<4.7. . ,~rg J!1!u, '.~. .. , .. . " ...,...........-.. ~.f~"-~ House Number Street Hamlet 53 S"- If County Tax Map N ,000 S, ction ... . . . . . . . . . . . .. Block ....... . . . . . . . . . .. Lot....,.............. Subdivision. .. , ...',',.,.,~..:',.... '...e.~. . . . . . . . . Filed Map No. ~~~. , . .. Lot'" ~. . . . . . . . (N e) 2. :f:::::,o::::::;'~~;z:: ~P'''' O:P~P~d ,,"""'''00........... b. Intended use and occupancy ............,.................................,.............. ... .... I " I ~ < _ '" ' ",I _it _1! 3. Nature of work (check whicp applicable): New Building. . . . . . . . . . Addition. . .1(. . . .. Alteration .......... Re~air ......... fri :::'al . . . . . , . . . . .. .. Demolition ...... i;;,;;;er Work. . (D~~~ri~ti~~) . . 4. EstJ111ated Cost. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this applieation) 5. If dwelling, number of dwelling ~nits . . . . . . . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . If garage, number of cars .....!................................................................... 6. If business, commercial or mixeq occupancy, specify ~ur;r and extent of eac~1je of use . . . . . . C)6 ,. . . . . . . . . . 7. Dimensions of e~sting structure~, if any: Front. . .. . f". . . . . . . Rear ... .......... Depth.. . . . . . . . . . . . . . Height ...../.......... Num,ber of Stories. . . . . !. . . . . . . . . . . . . . . . 7' . . . . . . . . . . . . . . . . . . . . p. . . . . . . . . . . Dimensions of same structure with alterations or ad~itions: Front ... 'f.r. . . . . . . . . . . Rear. . :I.'$'. . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . .:. . Height . . . r. ~. . . l' . . . . . . . . . . . Number of Stories . . . . . . . . ..;.,./. . . . . . . . . . 8. Dimensions of entire new constr)Iction: Front. . a.f. . . . . . . . .. Rear . . ~'. . . . . . . . . . Depth /;.. . . . . . . . . . . . Height ............... Numher of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size oflot: Front. .. . '" . . . .i. . . . . . . . ... Rear.......~ Depth ...................... 10. Date of Purchase .......... .i.. . " . . . . . . . . . .. . . Name 0 orme 0 .. . ., . .. . .. . .. . ... '" ., .... I J. Zone or use district in which pr~mises are situated. . . . . . . .. ........... ~ ;v.' . . . . . . . . . . . . . . . . . . . . . . . 12. D?es proposed construction ~tte any zoning law, ordina~ce or re~lation: ........f?....................... 13. Will lot be regraded ..... .~~ 'M' . . . .. . . . . Will excess fIll be removed from premIses: Yes No 14. Name of Owner of premises .!. . . . . . . .'-1tr':J'-4-. . . Address. . ~. . . . . . . . . . Phone No. ~.. . . .C- Name of Architect .. . . . . . . . .1. . , . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address .. . . . . . . . . . . . . . . . . . Phone No. ., . . . . . . . . . . . . . PLOT DIAGRAM Locate clearly and distinctly all' buildings, whether existing or proposed, and, indicate all set.back dimensions from property lines. Give street and block :number or description according to deed, and show street names and indicate whether interior or corner lot. ';:)4(; E' 13 LA/ J) . 1</' I ~ I t/~ %./ ~ . ~'~O(/$C G~I " &:f. -- \ Q:) Mo --- IJ3 I'Yy I~ /!~p __ \) J.. 1 - - '-, - - ~S-' ::X" I I / i.t ........')..., ~ ~ , ' 1:tt1' ;~ , ~' - 1771 STATEOFN~ iss COUNTY OF . . ..: . , . . . . . . . . . . . . . . . . . . . . . . . . . . . .i. . . . . . . . . . . . . , . . . . . .. being duly sworn, deposes and says that he is the applicant (Name of individual signing eontract) above named. ! He is the . . . . . . . . . . . . . . . . . . . . .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly 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 ?e performed in the manner set forth in the application filed therewith. Sworn to before me this : # r . ......... .of/.. .-:-...... .dayOf......~...., I~. ,~~=<: ~7 NotaryPubhc,. ... ... ......?,....~.. County 'd ' eRR'! JUOITH :r. T rk - , c state of New Notary Publl , , II 'Ik eoun'tY~ . . . . . . . . . . . . .. ............ ~ . . . . . . . NO. 52.0344969 .s~a~ch 30, 19 (Sig ature of applicant) eommis$ion Ii.><P're , ! , " ~ t<i t,1 j' , "', "':, , ' " : ,J . ""'- '. ." . ;....,,'.. . .,":" c.,',: -C.,.. .':. j ~~ " . 'j , ,\, .' 1 .()' ......,.. ."" . .,...0 ." - ,.' .'. , ;. I",. " ' ,1) '., '..',."... I"" ... ',' r,," , ':'~ "r.' 'VI, " ,~., .,..1.-' fh <1\ 10" -. 0.G\ VI J;). 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