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HomeMy WebLinkAbout24987-zFORM NO. 4 TOWN OF SOUTROLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25988 Date: 09/28/98 THIS CERTIFIES that the building ACCESSORY Location of Property: 1800 VILLAGE LA ORIENT (ROUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 24 Block 2 Lot 22 Subdivision Filed Map No. __Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 30, 1998 pursuant to which Building Permit No. 24987-Z dated JUNE 30, 1998 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 ACCESSORY GARAGE IN REAR YARD AS APPLIED FOR & AS PER ZBA #4571 The certificate is issued to WALTER & ALISON M MILLIS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF REALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 09/18/98 PLUMBERS CERTIFICATION DATED N/A Bui~ing Insp~tor Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 24987 Z Date JUNE 30, 1998 Permission is hereby granted to: WALTER & ALISON M MILLIS 1800 VILLAGE LANE ORIENT~NY 11957 for : CONSTRUCTION OF AN ACCESSORY GARAGE IN THE REAR YARD OF A SINGLE FAMILY DWELLING & TO THE CONDITIONS OF ZBA APP & CHPT 46 OF TOWN OF SOUTHOLD. at premises located at County Tax Map No. 473889 Section 024 pursuant to application dated MARCH Building Inspector. 1800 VILLAGE LA ORIENT Block 0002 Lot No. 022 30 1998 and approved by the Fee $ 135.00 uilding I ns~c~t or ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUP~~ This application must be filled in by typewriter OR ink and submitted inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form) 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% lead. 5. Commercial building, industrial building, multiple residences and similar buildir and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, o~ ~uildings an Vpre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Buildin~ - $100.00 3.Copy of Certificate of Occupancy - ~ .25~. 4.Updated .Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $1'5.O0 Date ...................... .... . . . . New Construction... ~ ..... Old Or Pre-existing Buildin~ ........ l'.ocation of Property...t ?. ................ ..~'..'.LI..~?..t~...~..~?...' ...... House No. Street County T~ ~p No i000, Section .............. Block ............ Lot ...... ',. ....... S~bdivisfon .............................. Filed Map ............ Lo t ........... ~ ....... ~oalth Dopt. ~pproval .... ~/~ ...... Hnde~rSeors ~pprovah~ 7~.~~. .... .............................. ........ WALTER MILLIS PO Box 183, 1800 Village Lane Orient, NY 11957 September 21, 1998 Building Department Town of Southold PO Box 1179 Southold New York 11971 Dear Building Department: Please issue me a C. O. for my new garage, building permit number 24987-Z. I enclose a completed application for the C. O. a check for $25.00 and the certificate indicating the New York Board of Fire Underwriters Certificate is in the process of being issued. Thanks for taking care of this. Sincerel~~ Walter Millis Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD September 18, 1998 Walter & Alice Millis 1800 Village Lane Orient, New York 11957 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) XX No Underwriters Certificate on file. XX The check is (not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 24987-Z Thank you for Please contact our office on this matter. cooperation. SOUTHOLD TOWN BUILDING DEPT. FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & .PLUMBING COMM£NT$ INSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: FINAL THE NEW YORK BOARD OF FIRE UNDERWRITERS PAG .i llT s .U.EAU oF L CTR,C,TY ~- 40 FULTON STREET, NEW YORK, NY 10038 Date SEPTEMBER 28,1998 Application No. on file 16836098/98 N 466532 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of WALTER MXLLIS, 180~ VILLAGE LANE, ORIENT, NY in the following location; [] Basement [] 1st FI. [] 2nd FI. GAR Section Block Lot was examined on SEPT~IMBER 1.8, i998 and found to be in compliance with the National Electrical Code.. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FIXTURE RECEPTACLES OUTLETS FLUORESCENT OTHER 2 i DRYERS S E R V I C NO. OF CC COND A, W, G. NO OF HI-LEG A.W. G, A W G, PER 0 O[~ CC. COND. OF ~[I- LEG NO. OF NEUTRALS OF NEUTRAL )THER APPARATUS: PARELBOARDS~ 1-2 CIR. 39 G.F.C.I~-i Q.C. ELECTRIC INC. P.0.BOX 518 Ia%UREL, NY, 11948-O518 LIC. #3823E GENERAL MANAGER 11 rhis certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT, THIS DOPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 765-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY REMARKS: [ ] ROUGH PLBG. [ ] IN~,ATION [ ~-'F'i'NAL Olj-DITH T. TERRY TOWN CLIgRi~ REGISTRAR OF V1TAL STA'I]STICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall. 53095 Mare Road P.0. l~ox I Southold, New York 11971 Fax (5[6) 765-1823 Tclepilonc (516) 765- 1801 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93)], and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)]. BLDG, D£P'T. ~ TOWN OF, SOUTHOLD,~D....~ Southold Town Clerk August 25, 1993 TOWN OF SOUTHOLD APPLICATION # PAGE 1 of 4 FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT tO read and si~n): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six montl~ of issuance. 6. Applicant is hereby informed that other permits may be required to fult'fll local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. ~.~. 8. I, THE APPLICANT, CERTIFY THAT~-~~~ALL STATEM~ENTS~H.~v~c~Z~.¢aNT) IN ATTACHMENTS TO (APPLICANT'S SIGNATURE)~-'~,~r'2~'/~'ff ~L~.~ ,/~ DATE.~.~'O/4 ~ O j q t~ SECTION 2: PROPOSED DEVELOPMENT (To be completed bv APPLICANT) NAME ADDRF_~S TELEPHONE APPLICANT BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION # PAGE 2 OF d DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE [] New Structure [] Addition [] Alteration [] Relocation [] Demolition [] Replacement [] Residential (I-4 Family) [] Residential (More t~an 4 Family) ID Non-residential (FioodprooFmg7 [] Yes) [] Combined Use (Residential & Commercial) [] Manufactured (Mobile) Home (In Manu- factured Home Park? FI Yes) ESTIMATED COST OF PROJECT $ B. OTHER DEVELOPMENT ACTIVITIES: [] Fill [] Mining [] Drilling [] Grading [] Excavation (Except for Structural Development Checked Above) [] Watercourse Alteration (Including Dredging and Channel Modifications) [] Drainage Improvements (Including Culvert Work) [] Road, Street or Bridge Construction [] Subdivision (New or Expansion) [] Individual Water or Sewer System [] Other (Please Specify). After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3: FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: El Is NOT located in a Special Flood H~2ard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). [] Is located in a Special Flood Hazard Area. FIRM zone designation is 100.Year flood elevation at the site is: Ft. NGVD (MSL) [] Unavailable [] The proposed development is located in a floodway. FBFM Panel No. Dated [] See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4: ADDITIONAL INFOILMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: [] A site plan showing the location of all existing structures, water bodies, adjocent roads, lot dimensions and proposed development. [] Development plans, drawn to scale, and specifications, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the Fa'st floor, details of floodproofmg of utilities located below the Fa'st floor and details of enclosures below the f'LrSt floor. Also, [] Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant ~nusA provide 100-year flood elevations if they are not otherwise available). [] Plans showing the extent of watercourse relocation and/or landform alterations. [] Top of new fill elevation Ft. NGVD (MSL). [] Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. [] Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this £mding must also be submitted. [] Other: SECTION 5: PERMIT DETERMINATION (To be completed bY LOCAL ADMINISTRATOR) I have determined that the proposed activity:. A. [] Is B, [] Is not in conformance with provisions of Local Law # , 19 attached to and made part of this permit. __. The permit is issued subject to the conditions SIGNED , D~,TE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPEALS: Appealed to Board of Appeals? [] Yes [] No Hearing date: Appeals Board Decision --- Approved? [] Yes Conditions Ul No APPLICATION PAGE 4 OF 4 SECTION 6: AS-BUILT ELEVATIONS (To be submitted bv APPLICANT ¢efore Certificate of Compliance is issued) The following information must be provided for project structures. This section must be completed by a reg/stered professional engineer or a licensed laud surveyor (or attach a certification to this application). Complete I or 2 below. Acthal (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas. bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FI' NGVD (MSL) 2. Actual (As-Built) Elevation of floodproo£mg protection is FY. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION ?: COMPLIANCE ACTION (To be comoleted bv LOCAL ADMINISTRATOR~ The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? [] YES [] NO DATE BY DEFICIENCIES? [2 YES [] NO DATE BY DEFICIENCIES? [] YES [] NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY for Attachment B SAMPLE CERTIFICATE OF COMPLIANCE Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED ' AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING [] EXISTING BUILDING [] VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS LOCAL LAW # ,19 SIGNED: DATED: OF COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # .~, 19__, AS MODIFIED BY VARIANCE # DATED ' SIGNED: DATED: C/C(93) 765-1802 BUILDING DEPT. , ~~~;PECTION [ ] OUNDATI 1ST [ ] ROUGHPLBG. [ N 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY FORHNO. 3 TO~ OF SOu'£HOLD BUILDING DEPARTHEWr SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE: .................. .4/i.4.]98 .. Walter Hillis P 0 Box 183 Orient NY 11957 PLEASE TAKE NOTICE that your application dated .~.}~ .......... 197~ .... remove ~y~?~l?~ for permit to ....... shed and re ace with accessory garage 1800 Will Location of Property .................... age Lane Or ent House No. Street Hamlet County TaXHap No. 1000- Section .24 ........ BLOCK 2 LOT 22 Subdivision ............................... Filed Nap No .......... Lot No ........ is returned herewith and disapproved on the following grounds ..~9~.~[~.~ ..... Section 100-30A.3 of the Bulk & Parking Schedule of the R 40 Zone- The removal of existing accessory shed of 64 Sq. Ft. with existing lot coverage of 23l and the construction of accessory garage at 320 Sq. Ft. will no~ become 26l + or - lot coverage which is ~y~ ~? ~p~d ~ ..................... ~ .the Bulk Schedule. Action required }LY~? ~JP~ }?~Y9 of Appeals. RV 1/80 APPEALS BOARD MEMBERS Gerard E Goehringer, Chairman James Dinizio, Jr. Lydia A. Tortora Lora S. Collins George Horning BOARD OF APPEALS TOWN OF SOUTHOLD Southold Town Hall 53095 Main Road EO. Box 1179 Southold, New York 11971 ZBA Fax (516) 765-9064 Telephone (516) 765-1809 June 29, 1998 BY HAND 6/29/98 a.m. Mr. and Mrs. Walter Millis Orient, NY 11957 Re: Appl. No. 4571 - Variance for Accessory Building Dear Mr. and Mrs. Millis: Enclosed please find a copy of the Appeals Board's determination adopted at our June 23, 1998 Meeting (at which Mr. Millis was present). We are today furnishing the Building Department with a copy for their open permit application file. Please do not commence construction activities until a building permit has been issued. You may wish to contact the Building Department directly at 765-1802 as a follow-up in this project for issuance of the pending building permit application. Very truly yours, GERARD P. GOEHRINGER CHAIRMAN Attachment (ZBA Decision) Original Decision filed with Town Clerk's Office Copy transmitted to: Building Inspectors' Office Gerard P. Goehringer, Chairman James Diniz[o, Jr. A. Tortora Lydia Lora S. Collins George Homing BOARD OF APPEALS TOWN OF SOUTHOLD Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 ZBA Fax (516) 765-9064 Telephone (516) 765-1809 FINDINGS, DELIBERATIONS AND DETERMINATION REGULAR MEETING OF JUNE 23, 1998 Appl. No. 4571 - WALTER MILLIS PARCEL 1000-24-2-22 STREET & LOCALITY: 1800 Village Lane, Orient. DATE OF PUBLIC HEARING: June ll, 1998 PROPERTY FACTS/DESCRIPTION: The subject property is located on the westerly side of Village Lane, Orient, and contains a total lot area of 8,346 sq. ft. The survey map submitted under this application shows that the subject premises is improved with a one-story frame dwelling and 8' x 8' accessory shed located in the rear yard not closer than 3' from the rear property Hne and 7' from the southerly side property line. The existing lot coverage for the dwelling is confirmed to be 1,847 sq. ft. for the house and 64 sq. ft. for the shed, for a total of 1,911 sq. ft. (23%). BASIS OF APPEAL: Building Inspector's April 14, 1998 Notice of Disapproval, disapproving a building permit application to remove existing shed and replace with accessory garage, which will exceed allowable lot coverage of 20%. AREA VARIANCE RELIEF REQUESTED BY APPLICANT: The applicant's request is to replace the existing 8' x 8' accessory shed with a new 16' x 20' garage at not closer than 3 ft. from the rear property line and not closer than 7' from the side property line, as presently exists for the shed. The new lot coverage as requested is an overall increase of 256 sq. ft. for a total lot coverage of 2,167 sq. ft (26+- %). The height of the garage is prOposed to conform with the Code at less than 18 feet. REASONS FOR BOARD ACTION~ DESCRIBED BELOW: On the basis of testimony presented and personal inspection, the Board makes the following findings: (1) Applicant has extensively remodeled an existing house located on a lot whose small size is typical of the neighborhood. The remodeling did not change the size of the house, which covers 22.1% of the lot. (2) the house has little usable basement space. There is an 8-by-8 foot shed at the rear of the property but no garage. In order to obtain adequate protection for an automobile, tools and beat equipment, applicant wishes to demolish the shed and build a one-car garage in the same rear-yard area. Page 2 - June 23, 1598 Appl. #4571:1000-24-2-22 (Millis) Southold Town Board of Appeals (3) The house al~ne covers 22.1% of the lot, and with the shed total coverage is 22.9%.~ thus, the only way that applicant can obtain the benefit of a garage! is by a variance a. llow~.'ng .lot coverage in excess of 20%. The propose~ garage is modest rn size but nevertheless increases the coverage (after Iremoval of the shed) to 26.0%. (4) Lot coverage o~f 25% is significantly greater than the 20% allowed by the Code. However, the lot coverage is already at nearly 23%, and the neighborhood is d~nsely built on small lots, with numerous accessory buildings. Thus, granting of the requested variance will not pro. duce an undesirable change in the character of the neighborhood or detriment to neighboring proper~es. (5) The reque.ste~variance w~ll not hay an adverse effect or impact on physical or environmental conditions in the neighborhood. The Board concludes that the following action is the minimum necessary and adequate to e~ble applicant to obtain the benefit of a garage w..hile also preserving al~d protecting the character , and at the same time preserves and protects the character of the neighborhood, and the health, safety, welfare of the community. RESOLUTION/ACTION: On motion by Member Collins, seconded by Chairman Goehringdr, it was RESOLVED, to GR~NT the variance as applied for. VOTE OF THE BOARD: AYES: M_..~RS GOEH_~I~NGER, DINIZIO, 24-2-22 (Millls) ~proved for Filing AI~EA = 8,346 sqft. SURVEY OF PROPERTY ,4 T ORIENT TOWN OF SOUTHOLD SUFFOLK 'COUNTY, N Y. 1000 - 24 - 02 - 22 Scale: 1' = 30' Oct. 10, 1996 Mar. 10, 1997 (Elevollons Added) CERTIFIED TO: WALTER MILLIS ALISON M. MILLIS CHICAGO TITLE INSURANCE COMPANY ~ 9608 C. 1230 SOUTHOLD~ N.Y, 11971 NO. 49618 BOARD OF HEALTtl ............... 3 SETS OF PL~,~S ~ ............. SURVEY ........................ CIIECK . .~ ..................... SEPTIC FOR~ ................... NOTIFY: ~r~ ~t; ........................ // Dar ................. , ~ · - a. 'Ibis application n~st be conpletely filled in by typewriter or in ink atw] zad~mitted to the P~tilding 1espector wi. 3 sets of plans, accurate plot plan to acale. Fee according to sd*edule. b. Plot plan ~hcr~ing location of lot and of buildings on pr~nises, relationship to adjoining pr~i~ee or ix,bllc streets or areas, and giving a detailed deserlption of layont of property mJat be drama ~ the d|agr~n ~lcb ia I~rf of thia nppl icat ico. c. 'lhe ~rk co, red by this nt~plication ~ay ~ot t~ cc~cenc~l before ia~oce o[ I~dlding Penuit. d. Upee approval of ~is a~licat{~, tl~ lhdldi~ lns~ctor ~il~ i$~ a ~ilding Pemlt to the applicant. ~mit d~all ~.bept on tim ~a avail~le for ins~ti~ thro~t tl~ x~rk. e. ~ ~ildi~ droll ~ ~pted or ~ in d~le or in ~rt for a~ ~ ~at~er mtil a C~rtlflcate of ~y dmH hme I~n ~ant~ by ~m ~dldi~ Ins~tor. ~,I~TI~ IS t~ ~ ~o tbe lhH]diog ~rt~nt for the ia~e of a ~ildi~ Pemit ~rmmnt to the I~ildi~ ~ ~i~ of fl~ T~ of ~tl~ld, ~ffolk ~n~, ~ York, ~ otlmr a~ltcable I~s, ~h~es nr ~lati~s, for tim ~t~ti~ of hdldi~, ~iti~a or alteratt~s, or for ~al or ~ltti~, as I~reln ~h~cril~. ~m applier ~s to c~ly w~th all a~hcable 1~, ord~t~es, ~ld~ng c~-x~, ..,: ..... ~ ............ ', (~ilh~ ~ress of n~ltcant) State v~tber applicant is o, mer, lea~e, agent, architect, e~stseer,' geeeral c~tractor, electrician, ph~r or I~ihle~ If applicant is a co. ratio, ~i~re of duly ~tl~>riz~l o[ficar. and ri~le o[ corporate officer) l~ilder~ License I~o ......................... · Pl~bers License fro .......................... Elecrriciana l.leeru~ ~ O[l~r ~ Licen~ ~ ..................... I. l~ari~ of la~ ~ ~dd~ p~l ~rk will ~ ~ ...................................................... *' ~';' .... ~nt~Tox~p~. I~ ~ti~ ~ Bl~k O ~ lot ..~.~. ....... ~Mivisi~ .......... ~ ................... Fil~ ~p ~ ................ lot ............... (~ 2. grace exlsti~ u~ a~ ~y o~ i~i~s a~ i~te~ tree ~ ~ of p~ c~stn~tJon~ . ~-S/p ~c~~ , . . ~ . . ...... a. F~sti~ ~ a~ ~y .................................. ~ ................. ................ ... ..... ........ ,.. ......................................... (to ~ ~id ~m filing thta al~licaci~) 6. If Inmi~aa, ~mrctal or ~i~l ~qm~, a~ai~ ~t.ura a~ extant o~ ~a~ tylm of u~ ...................... I~pth .................... I~i~t .................... ~t~Imr og 8torlaa ............... ............................ ~l)th ......... ...... lu .... .............. 15. Ia thia pm~rt~ ~lthln ~ f~:,of a tight ~tlaM~ * W~q .......... ~ .......... I)I.OT DIAORAH- frm~ proimr~y ll~a, Gt~ at~t m~l~bl~ ~mimr or t~aarlpti~ according to ~, a~ ~ atreet m~s ar~l tmlieaea ~dmtlmr interior or corer lot. I (C~ltrnct()r, ngei)~ ~ o ~r~)rate Offl(.eE, etc.) ()~ said (~mr or ~ra, a[Kl in duly ~thorJ~l to i~rfonn or I.~e l~rfim~l Lhe ~i(l ~[k taxi ~o rake a~xl fil. e Lhia a q)l 'caLtoli; Lhn{: all ~Lata~nt8 c(~)Lail~l il) tide n ~)J.t(:att(~l are tn~ to the I~et ~am~r ~t forth In the