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Home My WebLink About14664-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Of Occupnncy No. z14753 Date August 6, ........ ............................................. 19 86 THIS CERTIFIES that the building ........ .s.w.i.m.m..i.n.g.. p 9.o.1.. &...f.e.n.c..e ............... 53245 Main Road Southold, N.Y. Location of Property ~s~ ~/o[ ' ' 061 ~eet 8.1 Hamlet County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated September 24, 19.8.5 q4664Z ..................... , . pursuant to which Building Permit No ...................... dated March 1 7, 86 ............................ 19..., 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 ......... inground swimming pool & fence The certificate is issued to Margery Burns (owner~s~e:~c of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO... N 759772 Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: ............ ~.&....~.:~.,....!.}.~.~..~... ~o _~~,_~...~,~....~.~,..~...~..~.....~ ................ ...... ot premises Iocoted at ..~..~l..~...~...~.. ...... ....~....~.....~.....~. ............ ...~.~ .............. County Tax Map No. 1000 Section ....... .(~...~..L .... Block ...... ..~....~ ......... Lot No.....~.:...~ ............ __ ~urs~o,~, to o~,,~o,,on da,~ ..~..~L~....~ .......... , ,~.~.~, on~-- appro¥~ ~y ,~e Building Inspector. Fee $.~.~ .............. Building Inspector Rev, 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted aa laaaam=mm 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, street%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 sifnilar 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 pz~operty 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 requ ired to prepare a certificate, C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of bccupancy on pre-existing dwelling $15 o 00 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Jul7 2, 1986 5. Updated C.O. $15.00 Date .......................... P o o~1 .,~.n d Fence ~xewuu Iolng ............. O~d or Pre-existing Bui~dimg ............ Vacant Land ............. 53245 Main R,oad Southold Location of Property .................................................................. House No, Street Ham/et Owner or Owners of Property .... ~a,~ g.e.~.×. D....~.u..=.~,s ..................................... County Tax Map No. 1000 Section .q6 J ........... Block .. ,0.1 ........... Lot. ,8...1 ............ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No .... J ,4.6.6.4.Z:. Date of Permit . .3./. 1, 7/.8.6.Applicant ........ .~.a, r. 8.e.~.y' . p....~.u..~.~? ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate .................... Final Certificate Ye s Fee Submitted $..5 ..... . ,(~, .~ ,~,~ ,~. ............. Construction on above described building and permit meets all ~pplic~le codes and regulations. Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000708 BUREAU OF ELECTRICITY THIS CERTIFIES THAT in the followlng location; [] Bv~$ement ~ I st FI. u~s examined on July 14~ 1~q36 SIXTURE SWITCHES OUTLETS i 1 FIXTURES INCANDESCENT FLUORESCENT ~ 2nd FI. O~t~Sid~ Secthm Block Lot and found to be in compliance teith the requ re.tents of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS MOTOES S E R I C OTHER APPARATUS: I$~I~iN~_.~P~D_L_~) This certificate oovers cont011ance at the date of inspection only. Because of unusual envizmtmen~s it is advisable to have frequent test/and or repairs made by ~ qualified ~3.rson. sal Prato Wiggins Lm~e Greerpor~> N,Y. 11944 Mc. 104.9~ GENERAl. M~.NAGER 11 ~ This certificate must not be aStered in any manner; return to the office of the Board if incorrect. may be identified by COPY FOR BUILDING DEPARTMENT. TI'IlS COPY OF CERTIFICATE MUST,NOT BE ALTERED IN ANY MANNER. ,1802 IG DEPT. ~CTION' ROUGH PLBG. [/--~ FINAL REMARKS: DATE ./~/,//~/ INSPECTOR~ FIELD INS[~ECTION FOUNDATION {1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE ADDITION[L COMMENTS: JUDITH T. TERRY TOWN CLERK OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road~ P.O. Box 728 Southold, New York 11971 TELEPHONE (516) 765-1801 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON NOVEMBER 7, 1985: WHEREAS, Margery Dickinson Burns has requested that this Board waive the provisions of Local Law No. 14 - 1985 with respect to her application presently pending before the Southold Town Building Inspector, and WHEREAS this Board finds that the applicant proposes to construct an inground swimming pool at the rear of her residence at 53245 Main Road, Southold, and WHEREAS this Board deems such use consistent with the uses in a Hamlet Business District as proposed by Raymond, Parish, Pine & Weiner, Inc.'s Master Plan Update Zoning Code revisions, NOW, THEREFORE, BE IT RESOLVED that the applicant be and she hereby is granted a waiver of the provisions of Local Law No. 14 - 1985 to the extent of permitting such uses on said premises as set forth in her application presently pending before the Southold Town Building Inspector for a building permit, subject, however, to the applicant obtaining any and all permits and approvals required by all Town and other governmental agencies having jurisdiction thereof. Southold Town Clerk TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To: From: Re: Judith Terry Town Clerk Victor Lessard~ Exec. Admin. Waiver Request Margery Burns Upon checking our files I find that %he only papers we have are a building permit applicat- ion and a notice of disapproval dated October 10,1985. Attachment VL:dsm JUDITH T. TERRY REGISTRAR OF VITAL STATISTICS OFFICE OF THE TO~ CLE~ TO~ OF SO.HOLD October 25, 1985 Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 TELEPHONE (516) 765-1801 To; Southold Town Planning Board Southold Town Zoning Board of Appeals Southold Town Building Department ~ From: Judith T. Terry, Town Clerk Re: Waiver request - Margery Dickinson Burns Please submit all pertinent data in your files pertaining to the request of Margery Dickinson Burns for a waiver under Local /aw No. 14 - 1985 with respect to premises at 53245 Main Road, Southold. Attachment , ' RECeIVeD OCT 2, 5 m5 ,Town Clerk $outhold 6ROKER MARGERY DICKINSON BURNS Dickinson Real Estate Agency MAIN STREET, SOUTHOLD, L. I., N. Y. 11971 516 SOuthold 5-1640 October 25, 1985 SOUTHOt-;Y$ OLDEST AGENCY Est. 1921 Southold Town Board Southold Town Hall Southold, New York 11971 Att: Mrs. Judith Terry Re: #53245 Main Road, Southold, N.Y. #1000-061-01-8. 1 Dear Mrs. Terry and Board Members: ~' I would appreciate it very much if you will grant me permission to construct an inground swimming pool at the rear of nay residence on 1Vfain Road, Southold. Although the property is located in a business district, I am using the house as my residence and have since 1964 and the pool would only be used by me and my immediate family. Chris Schwarting of Southold Pools applied for a permit on September 23 to construct the pool. This application was disapproved because of B-1 General Business use. I applied to Mrs. I<owalski of the Southold Zoning Board of Appeals and she informed me that she is unable to accept this application. I am enclosing pholocopies of the survey of my property, copy of disapproval, copy of letter from Mrs. Kowalski and proposed sketch showing the location of the pool in relation to my house. Of course, the pool 'would have regulalion fencing and would be landscaped and treed. Again I would appreciate it very much if you will review the enclosed aud grant me permission. Sinc~y your s >~/_ Mar gery//Di~4~ins o/n Burns Enelosures ~- ~ ~'~, , ,'_ - TOWN O~ SOUT~IiOLD '<' ~: ,' ",, '~ TOWN CLERK'S OFF~CE .,,, ~ ' . '~ ~', ~5:, '-', ' ', '~7:," ':p~"~AS: ;FAK: NOTICE that your applkatlon dared .... -, "- ca. i,~ri iii lO .... ~fN'< >¢', · ,,.t ....... ~. -.7, e' . ."',:~:,;','-~": .' '-' ~ . ' 'OG/ k~ck ~ :,-' t,~.~.,,~;, ~P~.,~ Man No lO00 SeC~lOn ................... ,. , " :' Filed Map No/ '( '~' .., Stlbdlvlslo[l .............. ' ..... ' "" ~'is reitm~d tterewitl~ and disapproved On tile following grounds :" ' ' "'"' " ~ ~ ~ ' ;' .' ~' ,-, . Ap,~eAtS BOARD GERA~O P, GOEHFnNGER, eHAIRi~IAN ' CHARLES G~GON~S;' JR, ROBERT J, DOUGLASS ' ~OSEP8H SAWO~ ~ Mrs~ Margery . Burns .' ,"./SOU~oid, NY 1197] · : ~ Re. No~c of D~sapproval : Business ;'October'23','1985 Dated October Zoning .bistrict Office 'Further instructions may be of the Town Clerk. Dear Mrs. Burns. , I]'n~ 14:1'985 .'~ er the provisions of'Local Law ¢l , this . will.,confirm that our 'office is npt able'to accept your application for a var*iapce as disapprove'd by Bui.lding :,', Mr. Hi~dbr,ann has explained that the reason fo~ which he based his¢ disapproval is for a. struC'~ure :and. available through the . CC: Building Department ~ours very truly, GERARD" P. GOEHRINGER .- · '; .~. Prdoei~ty of Margery D Burns ~ ~ ,~ ~53245 Main Road, Southold, N.Y.., BLDG. DEPT. TOYVN OF SO[JTHOLD J JUDITtt T 'FERRY OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Roar~ P.O. Box 728 Southold, New York 11971 TELEPHONE (516) 765-1801 November 8, 1985 To: Southold Town Planning Board Southold Town Board of Appeals' Southold Town Building Department//'/' From: Judith T. Terry, Town Clerk Re: ~.~,~ .~ ~- Local Law No. 14- 1985 Attached hereto are copies of the ~[~i~~j~ of the provisions of Local Law No. 14 - 1'~§'g~3'~ f=~rSw,i~5 ap~J'~cants: JUDITH T. TERRY TOWN £LERK REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Roa P.O. Box 728 Southold, New York 11971 TELEPHONE (516) 765-1801 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON NOVEMBER 7, 1985: WHEREAS, Margery Dickinson Burns has requested that this Board waive the provisions of Local Law No. 14 - 1985 with respect to her application presently pending before the Southold Town Building Inspector, and WHEREAS this Board finds that the applicant proposes to construct an inground swimming pool at the rear of her residence at 53245 Main Road, Southold, and WHEREAS this Board deems such use consistent with the uses in a Hamlet Business District as proposed by Raymond, Parish, Pine & Weiner, Inc.'s Master Plan Update Zoning Code revisions, NOW, THEREFORE, BE IT RESOLVED that the applicant be and she hereby isgranted a waiver of the provisions of Local Law No. 14 - 1985 to the extent of permitting such uses on said premises as set forth in her application presently pending before the Southold Town Building Inspector for a building permit, subject, however, to the applicant obtaining any and all permits and approvals required by all Town and other governmental agencies having jurisdiction thereof. Judith T. Terry Southold Town Clerk Southo d Town Board o£ Appeals APPEALS BOARD MEMBERS GERARD P. GOEHRINGER, CHAIRMAN CHARLES GRIGONIS, JR, SERGE DOYEN, ROBERT J. DOUGLAS~ JOSEPH H. SAWlCKI October 23, 1985 Mrs. Margery D. Burns Main Road Southold, NY 11971 Re: Notice of Disapproval Dated October B-1 Business Zoning .District 10, 1985 Under the provisions of Local Law #14-1985, this ~ will confirm that our office .is npt able to accept your application for a var'ia.rice as disappro.ved by Bui.lding ! Inspector Hindermann. Mr. Hindermann has explained that the reason for' which he based his disapproval is for a structure and use of a swimmingpool which is not a permitted use under Article VII, Section 100-70(C)[1]. Further instructions may Office of the Town Clerk. be available through the Yours very tru,ly, cc: Building Department GERARD P. GOEHRINGERI CHAIRMAN ~ By Linda Kowalski FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL PLEASE TAKE NOTICE that your application dated ....-~.~.~..~..~..~'., 19 ( fo,' permit to C~..~&.'/d?..c77 .,.4)f?../pz.~l~'~.q~.~.O...~¢d.4 .g~...~.-..~.. ~'fl.qQ..~.... at Location o f Property ...¢. ~ ~ ..... ~ .~ ............ ~fQ~ .... HOUSO NO. Street ~ ~amlot County Tax Map No. 1000 Section . .O.~.( ...... Block ...O.d ........ Lot O~..: ....... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds ~O. ~.c~.~(T..~.. (?... ~... .o~.. x~... ~.~'..~.. P~2T~. .o~' ~.~ .~.5. . .:W...w:4 ................................... Building Inspector RV 1/80 Southold Town Board MAIN R[3AD- STATE ROAD 25 SOUTHOLD, L.I.. N.Y. 11971 TELEPHONE (516) 765-1809 ACTION OF THE ZONING BOARD OF APPEALS Appeal No. 3346 Application Dated December 20, TO: Mrs. Margery D. Burns 53245 Main Road Southold, NY 11971 ]985 (Public Hearing February 6, 1986) [Appellant(s)] At a Meeting of the Zoning Board of Appeals held on March ]0, ]986, the above appeal was considered, and the action indic-~--~w was taken on your [ ] Request for Variance Due to Lack of Access to Property New York Town Law, Section 280-a [ ] Request for Special Exception under the zoning Ordinance Article , Section IX] Request for Variance to the Zoning Ordinance Article VII, Section ]00-~0(C)[l] [ ] Request for Application of MARGERY D. BURNS for a Variance to the Zoning Ordi- nance, Article VII, ~i'o'n' 100-70--(~)[1] for permission to construct accessory inground swimmingpool upon premises known and referred to as 53245 Mai.n Road, Southold, NY, presently zoned "B-l" General Business; identified on the Suffolk County~Tax Maps as District 1000, Section 61, Block O1, Lot 008.1. WHEREAS, a public hearing was held and concluded on February 6, in the Matter of the Application of MARGERY D. BURNS under Appeal No. 3446; and 1986, WHEREAS, the board has considered all testimony and documentation entered into the record concerning this application;.and it is noted that there has been no public opposition; and WHEREAS, the with the premises area; and board members have personally viewed and are familiar in question, its present zoning, and the surrounding WHEREAS, relief was granted by the Southold Town Board on Novem- ber 7, 1985 pursuant to the provisions of Local Law No. 14-1985 in effect at the time of this application; and WHEREAS, the board made the following findings of fact: 1. The property in question is identified on the Suffolk County Tax Maps as District 1000, Section 61, Block 01, Lot O08.1,.consisting of a total area of approximately one-half acre with 84.68' frontage along the southerly property line along the north side of the Main Road, Southold. 2. The subject premises is improved with: (a) a single-family two-story frame dwelling and (b) a separate two-story garage structure with apartment, for which a variance was received on June 15, 1978 under Appeal No. 2430, and Building Permit No. 14242 was issued September 5, 1985. 3. By this application, appellant requests a Variance to (CONTINUED ON PAGE TWO) DATED: March 14, 1986. Form ZB4 (rev. 12/81) CHAIRMAN, SOUTHOLD TOWN ZONING BOARD OF APPEALS Decision Page 2 Appeal No. 3346 MARGERY D. BURNS Decision Rendered March lO, 1986 Article VII, Section lO0-70(C)[1] for permission to construct a 16' by 32' inground swimmingpool to be attached to the existing single-family, two-story frame structure with a five' wrap-around deck, leaving a setback from the westerly side property line from the deck at nine feet and erecting a fence enclosure, around the deck and pool structure, along the westerly property line and as shown by the February 10, 1986 sketch. 4. The premises 'in question is located in the "B~l" General Business Zoning District. In considering this application, the board has determined: (a) the relief requested is unique; (b) the relief requested is not substantial~ (c) there will be no substantial adverse change to the character of this district since the premises are and have been used for residential purposes, and the swimming- pool is accessory and incidental thereto; (d) the public health, welfare, comfort, convenience, order and safety of the town will not be affected by upholding this application; (e) the spirit of the ordinance will best be served by allowing the'variance, as conditionally noted below. Accordingly, on motion by Mr. Grigonis, seconded by Mr. Sawicki~, it was RESOLVED, to GRANT the relief requested under Appeal No. 3346 for permission to construct inground swimmingpool with attached decks, and fence enclosure, accessory and incidental to the existing residential use of the premises and not to be operated for gain or business purposes~ SUBJECT TO THE FOLLOWING CONDITIONS: l. The deck and pool structure be constructed no closer than 9 feet to the west property line as applied; 2. The deck and pool structure not be roofed (enclosed) at any time; 3. There be no lighting that would be adverse to neighboring properties.. Vote of the Board: Ayes: Messrs. Goehringer, Grigonis and Doyen. (Members Doyen and Douglass were absent.) This resolution was duly adopted. lk March. 1.4, 1986 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~.a~ ].~..., 19 ~).~' Disapproved a/c ..................................... 251985 Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necesshry il~e~ctil~':~ [~x- '~x~ Q~ ~ ~ ' (Signature of applicant, or name, if a corporation) /..IQ ,q.. &. ¢., v.c./. oo., , (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................................ Name of owner of premises ..... .~..~..~'. . ~>.~ .~/~. ................................................. (as on the tax roll or latest deed) If ~lica~corpo~}~io%sign~ ? f duiy authorized ,,officer. (I'qame and title of corpor ear, ricer) Builder's License No ...... . .~-./..~. .............. Plumber's License No ......................... Electrician's License No. ?.~.. 9.~...~ff~J..~..~ .... Other Trade s License No ...................... Location of land on which proposed work will be done.....~...~.6(..~../.J~. Al..%/...~¢}.& .~ ................ .. .... g..?. F.. ........................................................ House Number ~2~-~ g/~r,~ Street Hamlet County Tax Map No. 1000 ~ection ...~l.~d.~..~.(r.4~. Block .... .~.../ ........... Lot ..... .~..~./ ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existinguseandoccupanc .~,,&,_ ['~v,.,t.,U./ ~d~. {~C~. ,'{ b. Intended use and occupancy .../..~...~..~...~.lg.V.a~Y...r~D..'~...~:.. ~ ............................ ~ o~w"~6tle~ghich ~pplicable): New Building ..... ':.... 'Addition .......... Alteratiqn .......... :~ R~___. ~'~'t'~,, .t.'~',:j .. -'.. Removall .............. Demolition .............. Other Work,~,t-r~(Description) ~ {~ .L~... 4./. Eatin~a~-Cv!~.¥..... ,~ ."~./~., ....................... Fee ...................................... ~ pli ~, ,~ %:~-.. · .. ~,'t i i (to be paid on filing this ap cation) 5 If dwelling number of dwelling units Number of dwelling units on each floor ' If garage numberofcars ! .................. '.. 6. If business, commarcial 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 .............. N~Tnber of Sto~es ........ ................................................ 9. Size of lot: Front ......... ; ............ Rear ...................... Depth ...................... 10. Date of Purchase ......... i ................... Name o,fFormer Owner ............................. 11 Zen di trict i hich premises are ituat d ~:) te-~l.~/~ ~-~. · e or use s n w s e .......................................... 12. Does proposed construction viblate any zoning law, ordinance or regulation: ,/Y3~. ............... ....-,, ........ 13. Will lot be regraded ..... ~ .................... Will excess fill be remoyed from premisesl ~ No 14. Name of Owner of premises , ('O(~e~.)r..~4~.~:, Address .~.~.~.~f.m..~.~..~.~. Phone No ............... Name of Architect ........ .................. Address ................... Phone No ................ Name of Contractor ~,~.l.b.~O~ r'2...~.e~.L..%.. 1109.... Address £ .~&q~..-¢..~.,b .~..~.. D.a,.Phone No. 7.~,.~. .... : PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from iption according to deed, and show street names and indicate whether : number or desc: property lines. Give street and blocl interior or corner lot. ..' STATE OF NE)~/Yg.~K,. ~ i S S · ................being duly swo , deposes and says that he is the appiicant (Name of individual si~ning qontract) above named. He is the ..................... (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 be performed in the manher set forth in the application filed therewith. Sworn to before me this ....... : ...... .~?.~.~,'..