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HomeMy WebLinkAbout15233-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20929 Date AUGUST 12~ 1992 THIS CERTIFIES that the buildin~ ADDITION Locatmon of Property 1345 INDIAN NECK LA & 50 SPRING LA. PECONIC~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 86 Block 5 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the ~ppllcatlon for Building Permit heretofore filed in this office dated AUGUST 25, 1986 pursuant to which Building Permit No. I5233-Z dated SEPTEMBER 4~ 1986 was issued, and conforms to all of the requirements of the appIlcable provisions of the law. The occupancy for which this certificate is issued is ADDITION TO AN EXISTING BUTLDING AS APPLIED FOR. The certificate is issued to GRR~NPORT CONGREGATION OF JEHOVAH'S WITNESS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ~THAPPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-788881 - JANUARY 19~ 1987 PLUMBERS CERTIFICATION DATED FEB. 18~ 1987 - GERALD F. WOOD Rev. 1/81 ' // B611dlng Inspector OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, 1'4. Y. BUILDING PERJ*,~IT ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15233 Z Date ......................................... 19 .. Perrmsslon is hereby granted to',., ............................... ...Y~~.....~..:~.:...!!...~...¢..~.. .......... et prem,ses located at ~/.~...~.~....~.~ ...~J~ '20~";';~.'.'~.".'~ ....... ;"" .~...~_;'" k,J ..~.""~' ~- ;~ ~ CounW Tax Map No 1000 Sec~ ~ 3.~ . "'~k .... .~.~ ....... Lot No..~.J .......... Building Inspector. Fees ,~..:...'~.... Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Th~s application must be filled ~n typewriter OR ink, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate Iocat)on of all buildings, property lines, streets, and unusual natural or topographic features. 2. F~nal approval of Health Dept of water supply and sewerage disposel-(S-9 form or equal). 3. Approval of electrical Installation from Board of F~re Underwr~terSo 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 s~te plan requirements where applicable. For existing buddings (prior to Ap.I 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topograph m features. 2. Sworn statement of owner or prewous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent mforma- t~on required to prepare a certificate. C. Fees' 1. Certif[cate of occupancy New Dwelling $~25.D0, Accessory ,$10.00 Business $50.00 2 Certificate of occupancy on pre-existing dwelling $ 50.00 3 Copy of certlflcate of occupancv $ 5.00, over 5 years 4.Vacant Land C.O. $ 20.00 ~.2~/.~. S.Updated C.O. $ 50 00 Date . ?. ............... NewConstruction ...... Old or Pre-exmtmg Building ........... Vacant Land ............. Location of Property , ,/~.~ ,¥,../,,/~,0/.~¥¥., ,/~/Arq~,.,, .4, .~-~.., ,~., ,5'.C~,., ?. ,P,,~(,z2F.' , .,<~. <~,`, Hou~ No. Street Nm/et Owner or Owners of Prope~y .~C~ ~..~ . f{~. ~, T,x Map No. 000 ....... ...0. ........ Lot . .......... Subdivision ............................ Filed Map No ........ Lot No ........... Perm,t No. l ~'.2 .~. ~.. Date of Permit .?/..~/J~....Apphcant ~..'¢~.'~/. Health Dept Approval Labor Dept Approval .... ., 7~'~ ~- ~/ ..... Planmng Board Approval .~Y.~.. Underwriters Approva xz. .......................... ,. tiff Request for Temporary Certificate ................ Final Car cate ....................... Fee Submitted $ .~..~..~.o. ................... Construction on above described budding and permit meets all apphcable codes and regulations. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N Y. 11971 TEL. 765-1802 CERTIFICATION Date Bullaing Permit No. /~ ~%' ~ Owner ~,~e~/,,~.~r//*~,?, ~c~.e~,,~'~,~,,. o~_ 3e~v~' ~,~ (please print) Plu~er ~ ~Z O ~, (please prznt) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this of. Notary Public, No ~0 4~AJSO0 Notary Public County TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O BOX 728 TOWN HALL SOUTttOLD, N.Y. 11971 To Whom This May Concern, TEL. 765-1802 We are unable to complete your Certificate of Occupancy because,of the following reasons. /5/ An applzcation for Certificate of Occupancy is not on file. /-/ NO Underwriters Certificate on file. /~'/The check ls(outd~/not on file.);2~qOC3 /5/ No Ilealth Dept. Approval on file. /5/ No final Inspection has been made. Please conLact our office on this matter. Thank you for your cooperation. Bul]dlnq Permit I~ J ~ ~ ~ ~ g BuLldlng Dept. ***/~/ NO Plumber Solder Certificate on file. ( all permits %nvolving plumbing being issued after April 1,1984 ) OCCUPANCY OR USE IS UNLAWFUL WITNOUT A CLEAR UP THIS MATTER AS SOON AS POSSIBLE SO HAVE TO BE TAKEN. Thank you. CERTIFICATE OF OCCUPANCY. THAT LEGAL ACTION DOES NOT The Peconic Congregation of Jehovah's Witnesses Indian Neck Lane, Peeonie, New York July 31, 1992 Office of Building Inspector Town of Southold PO Box 1179 Southold, NY 11971 Attention Gary J. Fish Re: Premises: 1345 Indian Neck Lane Peconmc, NY Suffolk Co. Tax Map ~1000-85-5-1 We have completed the two things your department requested 1--Second storm drain and 2 cover for the parking lot light. Enclosed ms a check for $25.00 for the Certificate of Occupancy. If there are any questions please call me at 298-4982.. Yours truly, Leo D. Russell F1ELD INSI~ECTION FOUNDATION FOUNDATION (~2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: Town Hall, 53095 Main Road PO Box 1179 Southold, New York 11971 PLANNING BOARD OFFICE TOWN OF SOUTHOLD SCOTT L HARRIS Supervisor Fax (516) 765-1823 Telephone (516) 765-18 M_arch 29, 1990 Leo Russell Bergen Avenue Matt~tuck, NY 11952 RE: Site Plan for Jehovah's Witnesses Church SCTM~ 1000-85-5-1 Dear Mr. Russell: The Planning Board made an inspectIon of the aubove referenced property on March 28, 1990. The Planning Board will not recommend the issuance of a Certificate of Occupancy until the following items are addressed: The lights must be shielded from the adjoining properties. Two drainage basins must be installed in the parking area at the low spots in order to prevent stormwater from running ~nto Ricb~nond Creek. The Board did notice that one drain had been installed as per the Board's request of April 15, 1987. The enclosed map shows the recommended location of the second drain which was requested in the Aprll 15, 1987 letter. Please notify this off~ce when you have completed the above items. Another field inspection w~ll be scheduled at that time. Page 2 Jehovah's Witnesses If there are any additional questions or if you require further guidance please do not hesitate to contact this office. Very truly yours, Bennett Orlowski, Jr. ~ Chairman Encl. cc: Victor Lessard, Principal Building Inspector INSPECTORS Victor Lessard Prmc~pal Buddmg Inspector Curtis Horton Sensor Buddmg Inspector Thomas Fisher Bmldmg Inspector Gary Fish Bmldmg Inspector Vincent R. Wieezorek Ordinance Inspector Robert Fisher Assistant F~re Inspector Telephone (516) 765-1802 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O Box 1179, 53095 MamRoad Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD November 27, 1991 Mr. Leo Russell Bergen Avenue Box 243A Mattituck, N.Y. 11952 Re: Premises: 1345 Indian Neck Lane, Peconlc, N.Y. Suff. Co. Tax Map ~1000-85-5-1 Dear Mr. Russell: During a review of our flies, it was noted that the above building permit has expired and a Certificate of Occupancy has not been issued. In order for us to issue the CO, final Site Plan approval from the Planning Board is required. Attached is a copy of a letter dated March 29, 1990 from the Planning Board to you stating what their requirements are. Also we will need a check from you in the amount of $25.00 for the Certificate of Occupancy. We would like to bring to your attention that it is unlawful to occupy or use said structure until the Certificate of Occupancy has been issued for for this bullding permit. Please contact this office as soon as possible so that we may clear up this matter. Thank you in advance for your anticipated cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. cc to: Gary J. Fish, Building Inspector Peconic New York Congregation of Jehovahs Witnesses GJF:gar Southold, N,Y, 11971 (516) 765-1938 August 5, 1986 Mr. Leo Russell Presiding overseer The Peconic Congregation of Jehovah's Witnesses IndianNeck Lane Peconic, NY 11958 Re: Site Plan for the Jehovah's Witness Church located at Peconic Dear Mr Russell: Please let this confirm the following action taken by the Southold Town Plannlng Board, Monday, August 4, 1986. RESOLVED that the Southold Town Planning Board approve the site plan for the "Greenport New York Congregation of Jehovah's Witnesses" located at Indian Neck Lane, Peconic for construction of an addition on an existing church, survey dated as last amended July 16, 1986, subject to: 1. A one-year review. 2. All parking for this use should be kep on the premises (on-site) at all times. Th~s proposal received a special exception and was certified by the Building Department. Would you please forward three (3) surveys for the Chairman to endorse, upon his endorsement, we will forward one to you. Please contact this off~ce if you have any questions. Very truly yours, BENNETT ORLOWSKI, JR. , CHAIRMAN ~OUTHOLD TOWN PLANNING BOARD 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING REMARKS: FINAL INSPECTOR 765-t80~ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION REMARKS: .... ? DATE INSPECTOR ~-~-'~. ~ BUREAU OF ELECTRICITY THIS CERTIFIES THAT ~m ~e, Pcconic, N.Y. OTHER APPARATUS 1-5 ~on A.C- Un~ 3 Emerc~nc¥ I,i~~, Ss~ ,Ces~ 141N. F~rry Pd. She~tnr Island, ]~n64 ~ iv. ~205S-F GENF~AL MANAGI~I 1! Pen This ¢ertff~cate must not be altered in any manner, return to the off~ce of the Board ~f incorrect Inspectors may be identdmd by their credentials COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MAHNER Southold Town Board of Appeals NIAIN ROAD- ~TATE ROAD 25 BOLITHOLD. L.I.. N.Y. 11g'71 TELEPHONE (516) 765-180g ACTION OF THE ZONING BOARD OF APPEALS Appeal No. 3498 Application Dated April 28, ]986 TO: Mr. Leo D. Russell for GREENPORT N.Y. CONGREGATION OF JEHOVAH WITNESSES 5550 Bergen Avenue Mattltuck, NY 11952 [Appellant (s) ] At a Meetlng of the Zoning Board of Appeals held on June 25, ]986 the above appeal was considered, and the action indicated below was taken on your [ ] Request for Variance Due to Lack of Access to Property New York Town Law, Section 280-a EX] Request for Special Exception under the Zoning Ordinanc~ Article III, Section ]00-30(B)[2] [ ] Request for Variance to the Zoning Ordinance Article , Sectlon [ ] Request for Application of GREENPORT N.Y. CONGREGATION OF JEHOVAH WITNESSES for a Special Exception to the Zoning Ordinance, Article ~, Sect]on lO0-30(B)L2] for permission to construct addition and establish same for religious,,library use, at 1345 Indian Neck Lane (a/k/a 50 Spring Lane), Peconic, NY; County Tax Map District lO00, Section 86, Block 5, Lot I. WHEREAS, a public hearing was held and in the Matter of the Application of GREENPORT JEHOVAH WITNESSES under Application No. 3498, concluded on May 22, N.Y. CONGREGATION OF and WHEREAS, the board members have personally viewed and are familiar with the pmemises in question, its present zoning, and the surrounding areas; and WHEREAS, at said hearing all those who des]red to be heard were heard, and their testimony was recorded; and WHEREAS, the board has carefu]ly considered all testimony and documentation submitted concerning this application, and WHEREAS, the board made the following findings of fact: 1. By this appl]cation~ appellant requests a Special Excep- tion to the Zoning Ordinance, Article III, Sect]on 100-30(B)[2] for permission to construct a 27' by 30' addition along the easterly side of the existing building for use as a llbrary ]n conjunct]on with the Greenport New York Concgregation of Jehovah's Witnesses use as a religious establishment. The addition will be set back not closer than 24 feet from the southerly property line and 70 feet from the easterly property line, all as shown on survey amended March 7, 1986, prepared by Roderick VanTuyl & Son. 2. The premises in question is located ]n the "A" Res]- dent]al and Agricultural Zoning District, containing a lot area of 20,625~ sq. ft. with 165' frontage along the south s~de of Spring Lane and 125' frontage along the east side of Indian Neck Lane. The surrounding properties are also located ]n the "A" Zoning District. .(CONTINUED ON PAGE TWO) 1986 DATED: June 25, 1986. Form ZB4 (rev. 12/81) CHAIRMAN, SOUTHOLD TOWN ZONING BOARD OF APPEALS Page 2 - Appeal No. 3498 Matter of GREENPORT N.Y. CONGREGATION OF JEHOVAH WITNESSES Decision Rendered June 25, 1986 3. The subject premises is presently improved with an one-story frame building of approximately 1,680 sq. ft. which is set back 40 feet from its front property line along Spring Lane and 38 feet from its front property line along Indian Neck Lane, and 24 feet from the southerly property line. 4. It is noted that this pro2ect will require site-plan and parking approval from the Southold Town Planning Board, which is pending this board's determination at this time. In considering this application, the board f~nds and determines that: (a) the use requested will not prevent the orderly and reasonable use ot ad2acent properties or of properties in adjacent use distr~cts; (b) the use will not adversely affect the safety, welfare, comfort, convenience or order of the town; (c) the use is in harmony with and will promote the general purposes and intent ot zoning. The board has also considered subsections [a] through [1] of Article XII, Section IO0-121(C)L2] of the Zoning Code. Accordingly, on motion by Mr. Goehr~nger, seconded by Mr. Douglass, ~t was RESOLVED, that a Special Exception for permission to construct an addition of a maximum size 27' by 30' as shown on survey amended March 7, 1986, prepared by Roderlck VanTuyl, P.C. for religious/library use, as applied under Application No. 3498 in the Matter of GREENPORT NE_]~..Y-O~.~CONGREGATION OF aE.OV^H TNESSES, BE ^ND- HEREB ..~,- That parking rjr this use should be kept on the premises (on-site) at all times. Vote of the Board: Ayes: Messrs. Douglass and Sawicki. (Member Doyen was tlon was duly adopted. Goehringer, Grigon~s, absent.) This resolu- lk GERARD P. GUEHRINGER, CHAIRMAN July 10, 1986 FORM NO 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL PLEASE TAKE NOTICE that your apphcation dated . ~(~.. ~. ........ , 19 ~.. Sub&wsmn ............ Ffl~d Map No ............... ~t No .............. ss returned herewith and d~sapproved on the following grounds ....................... .... ,,,~.s.a. . ./~,,,.,,,~,,,~. . z~,~. ~4ro. . ~+~,~., .~,-~ .~. . .7.~. . .... . . . .~. ~, ..... ,~.,'~. . . .~. ~. . z~. ~. . ~ ........ ~. ............... Rv 1/80 Examined . . . , 19 Approved , 19. Disapproved a/c . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y. 11971 TEL. 765-1803 Permit No Recezveff~. ......... 19. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tlus application must be completely filled m by typewriter or m ink and submitted to the Bmldlng Inspector, with sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing locatmn of lot and of bmldmgs on premtses, relationship to adjoining premises or pubhc strec or areas, and g~vmg a detaded description of layout of property must be drawn on the dtagram whmh is part of this app caB. on. c The work covered by tins application may not be commenced before issuance of Budding Permit. d Upon approval of this apphcatmn, the Bmldmg Inspector will issued a Bmldmg Permit to the applicant Such perm shall be kept on the premises available for mspechon throughout the work. e. No budding shall be occupied or used ~n whole or ~n part for any purpose whatever until a Certificate of Occupam shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Bmldmg Permit pursuant to tl Bmldlng Zone Or&nance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordmances, Regulations, for the constructaon of buddings, add~ttons or alterations, or for removal or demohtlon, as hereto describe, The apphcant agrees to comply with all apphcable laws, ordinances, budding code, housmg code, and regulabons, and t aflrmt authorized mspectors on premises and m budding for necessary ~nspechons (Stgnature of applicant, or name, if a corporation) (Madmg address of applicant) "~ ' ~ .z.--* ,. State whether apphcant ts owner, lessee, agent, arcintect, engineer, general contractor, electrician, plumber or bmldet Name of owner of premmes (as on the tax roll or latest deed) If apphcant is a corporation, stgnature of duly authorized officer (Name and title of corporate officer) guilder's License No Plumber's License No / 7 7 ~ P .... Electrician's License No .~ O..~.~-.-- .~' Other Traders License No Location of land on which proposed work will be done. Itouse Number ~"~ e' ~,4 o Street County Tax Map No 1000 Section dS)~ Hamlet Block (~-~ Lot. a Existing use and occupancy b Intended use and occupancy Subdivision Filed Map No .. Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction 3. Nature of work (check which applicable): New Budding .. Ad&tlon /~ ' .... Alteratmn .. Repmr Removal Demolition ...... Other Work ...... (Description) 4. Estunated Cost ,2.,'> (i,q ................ Fee ...................... " (to be paid on fihng th~s apphcatmn) 5 If dwelhng, number of dwelhng units ....... Number of dwelhng umts on each floor ....... If garage, number of c~ 6, If business, commerct~ or m~xed occupancy, specify nature and extent of each type of use .......... 7 Dxmensions ofex~stmg structures, ffany Front .,, 2. . . Rear . ,~'. . Depth CZ. ' .... Height /'c ...... Number of Stones [ .................... r., Rear g" D~ensmns of same structure w~th aiteratmns or add~tmns Front . ~ ~ .................. Depth ~ 5.5 He~t. /~-.~ .. . Number of Stones ./ .......... 8 D~enslons of entire new construction Front ..... Rear ........... Depth ....... Height ..... Number of Stones ........................... S~zeoflot Front ,:~ ...... Rear. a-~,~ ..... Depth ./a ~ ........... Date of Purchase ~ q,: ~ ~ Y .. . . Name of Foyer Owner 7 ............. Zone or use &stnct an which premases are s~tuated .................... Does proposed construction vmlate any zomng law, ordinance or regulation .~' ~, ................. Will lot be regraded ~ ~ ......... W~ll excess fill be removed from premises ~ Yes N~e of Owner of premises ~,v~ C~, ~, ~.v~A~ress . . . Phone No 2~C:.;;?~'.~. , N~e of Architect ~,~'~'~, d., ~4~.~~ ., Address ~ .9~;':'a ~g. ~d~'~,Phone No. ~"5~..-, ~',,3.~, Nme of Contractor ,; ,~, ~ ~'? ,~.o ~ ~*~,7 Addre~ .......... Phone No, A 10 11 12 13. 14. PLOT DIAGRAM Locate clearly an(~ dlstmctly all buddings, whether existing or proposed, and, indicate all set-back dnnensions from property hnes Give street and block number or description according to deed, and show street names and indicate whethe, interior or corner lot. ~ STATE OF NEW/Ygl~K. ? .. ,. COUNTY,OF ,~d~.d/~-4'~ . a ~ . . d~-d ¢..~S(~ ~ .. . being duly sworn, deposes ~d says that he is the apphcant (Name of ~n&v~dual signing contract) above n~ed Helsthe ~P~Ze--~~2 .. ¢~ *~e .... (Contractor, agent, corporate o~ficer, otc ) of sa~d owner or owne~, ~d is duly authorized to perfom or have perfo~ed ~e said work and to m~e ~d fi12 flus apphcatmn; that ~ statements contmned ~ th~s apphcatmn are true to the best ofh~s knowledg~ and behef, and that the work wgI be perfo~ed m ~e m~ner set for~ m the apphcatton filed therewith Sworn to before me this ...... c~..: .,,. dayof ..¥~C.~.., County (Signature of applicant) 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 .q.., DzsaDproved a/c .............................. (Building Inspector) APPLICATION FOR BUILDING PER~IT INSTRUCTIONS a. Tlus application must be completely filled m by Wpewnter or in ink and submitted to the Building Inspector, wltl ;ets 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 adjolmng premises or pubh¢ sire >r areas, and giving a detailed descnpuon of layout of property must be drawn on the d~agram which is part of this ap! ation. c. The work covered by tlus apphcation may not be commenced before issuance of Building Permit d. Upon approval of this apphcatlon, the Building Inspector will ~ssucd a Building Permit to the applicant. Such peru hall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupan ·hall have been granted by the Braiding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Imlding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ~egulations, for the construction of bmldmgs, additions or alterations, or for removal or demolitmn, as hereto describe ~'he applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and tdm~t authorized respecters on premises and m building for necessary inspections. (Signature of apphcant, or name, if a corporation) (Mailing address o f apphcant) "~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmlde es . .......................... (as on the tax roll or latest deed) f apphcant is a corpomtmn, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ,.~2.~& F Plumber's L~cense No... !.7.7...3..?. ......... Electrician's L,cense No...'"?' 0.~. .~. 7 .~. .... Other Trade's License No .................. Locat:on of land on winch proposed work will be done. ~'.,~,~,/.~.~ /-~e ~,,~ . ?.'.~'~v< tL?, o · ....... ~ ~/~q .... ~', Street Hamle~ ltouse Number ~ r~ County Tax Map No. t000 Sectmn . O~ ........ Block .. 0~ ... Lot .~ / Subdivision .............................. Flied Map No ........ Lot ............. (Name) State emstmg use and occupancy of premises and intended use and occupancy of proposed construction a Exlstmg use and occupancy ./i~..-a~.~/c,,,~ .. ;~t.,,%/o~.,.~,e r.~..o.~:~.o~ b Intended use and occupancy . . ~.~ ~/ /~ .~J~. ~/~ 3. Nature of work (check which applicable): New Building ......... Addition . /~' ~ Alteration Repair ............. RemovaI .............. Demolition ....... :... Other Work ............. (Description) 4. Estimated Cost .... .~ ¢.e.q ...................... 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 ears .............................. 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .................. 7 Dunansions of existing s~ructures, if any Front.. Z .'i ...... Rear . .~.o. ......... Depth . 2 % .~ ..... Height . ,/g?. ., ...... Nmnber of Stones . t' ..... Dimensions of same structure with al.terations or additions Front .,':.. ........ Rear . ~ c.. ............ Depth . ~q ..... ~,.~, ......... Height .. Y.F,.. e . Number of Stones .d. 8. Dimensions of entire new construction' Front ....... Rear ........... Depth .......... Height .............. Number of Stones .......................................... 9 Size of lot. Front ../.4~. ~ ... Rear. /..-- ............. Depth /- . ............. 3. Date of Purchase doc /CZ ,; . Name of Former Owner ~ 1 Zone or use district in which premises are situated 2. Does proposed construction violate any zoning law, ordinance or regulation' .Xt~ C~ ................. 3 Will lot be regraded ../t,%q ................. Will excess fill be removed from premises' ~/Yes N ......... No.,.E ....... ~ Name ofOwnerofpremlses4~,*,.J,~.,v/f',.v~.%,..-r:~:,v A dress .... Phone ' "--* ~; -> Name of Architect .~F~r~. ~..r~'. g, .,~.4-A'.42~-.c~'/... Address~??f..'t~.- ..a ~,.;../?~... Phone No l' %~ - goJ3~ Name of Contractor ..-~...~Y.< .~.. ~.o..,~.o..~..,. ~vr?.~,/. Address s .~ se oz:e ~ ~ . Phone No. A ?;L .?fi.~f '~.. PLOT DIAGRAM Locate clearly and dlstmctly all buildings, whether exlsnng or proposed, and indicate all set-back dimensions fro, ~operty lines. Give stleet and block number or descnptlon according to deed, and show street names and indicate wheth, tenor or corner lot t rATE OF NEW/Ygg. K, l ~ ~ OUN rYJ)FF '. ..... .. ~ .g'j'b...'~.: _~.0'.~ .~.~.-.d= ~ ................ being (Name of individual signing contract) ~ove named. duly sworn, deposes and says that he is the applica~ e is the .~'?../i'.,q~,r&,~ F.-~-~ ... e~f ~;~ ......... > ...... (Con,actor, agent, co,orate officer, etc ) smd owner or ownem, ~d ~s duly au~omed to perfom or have perfomed the said work and to m~e and file tb Cmatmn; that ~1 statements contused ~ this apphcatmn are true to the best ofh~s ~owledge and behef, and that tl ork will be perfomed m the m~ner set for~ m the apphcatmn filed therewith. ;om to before me this .............. dayof .... ; ........ 19 fi~.. ~,o .~ ;'~ ~, (S~gnature of apphca~ 1' ~ AppI~OVED AS NOTED NOTIFY BU~u "~ ' 765:1802 9 AM TO ~ ~ ~R THE LLOWING iN~PECTIO~ ~O~. NOT R~s~NSt~E ~R m~IGN OR CC,~STRUCTiON r' ~ piping itmll be T, JA~5 " OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY PLUMBER CERTIFICATION ON lEAD CONTENT BEFORE ~ER~IFICATE OF OCCUPANCY F. ~EAL¥ VAI~' TLJ'Y'L, ~ It FF, ONT ~/~' ~H~-~-.TI~o.C-~ - A.P~O'VE.. ,~ T JC~,Tc 14 out ~ 'T&r: I J 0.. -/: ELECTI~ICAL W'Ol~lt~ ~ TO 'C. OI~IIIKI~'TO L.OCAL.~N.F...C, L~A~O~ A~ tN~IC~TE~ '~ ~ATC~ ~T~ ~l~(~H, , ',':, . t-I d ,,I , ,. INSLILA~! -. Top ~c~c~ ' , ~'OUt,4 PATiOI~ .F:' L.A, 1~... T ~XISTING AL~F~ NT~IZ, IOIvN ~ .............. 27'-~" INEW AG'I~tTITi ~,N - ..........