HomeMy WebLinkAbout24647-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26581
Date: 07/21/99
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 1530 CROWN LAND LA CUTCNOGUE
(HOUSE NO.) (STREET) (~AMLET)
County Tax Map No. 473889 Section 102 Block 7 Lot 9
Subdivision Filed Map No. Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 6, 1998 pursuant to which
Building Permit No. 24647-Z dated FEBRUARY 6, 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 ONE FAMILY DWELLING WITH FRONT PORCH AND ATTACHED TWO CAR G~RAGE AS
APPLIED FOR.
The certificate is issued to STEPHEN T. & LISA P. TETTELBACH
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-97-0186
ELECTRICAL CERTIFICATE NO. 27337
PLUMBERS CERTIFICATION DATED 07/14/99 THOMAS MAFFETONE
Rev. 1/81
07/14/99
07/14/99
uilding I~
FORM NO.$
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTI'IOLD, N.Y.
24647 Z
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission Is hereby granted to:
........ .T, F,, .T, ,T,~;~,~ ~,~;H/F, ,B ~I~,,Y,,, F,,D,,~ 0,~ ...........................
........ ,1,.7..~...l~.Qfl.:~.~:hl~.~..~.V,~., ............................ : ...........
........ ~/~.T. ~.~ ~ ~.Y.... ~.:k~.,~ .............................................
........ ~). ~.I~.P...~B.O~J.~P...P..~B.~hL.~...~P...P.k,~,F,,~...E~.I~., ............................................................
at premises located at ................ j..5.~.O........C..R...q.N...N....L,~..p...~...~ ................................ .~ L).T,G.IrlD.~U~ ........
CountyTax Map No.....4..7..~.~. ,~.~ ..... Section ...~..0..2, ............. Block ..... .0..~.(~.7. ........ Lot No..~.~.~. ...............
pursuant to application dated.,..~.~.N.,.u,~..R.,Y. .......... ..&. ........................ 19 ...... ~..q ..... and approved by the
Building Inspector.
Fee $.....,~ ~.~.....b..O....,.
Rev. 6/30/80
Building Inspecfor ~/
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN F~LL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of ali 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 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
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.
Fo~ existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
'!pr~-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
~unusual hatural 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.
]. 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 Buildinm - $t00.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $.15.00, Commercial $15.00
. ./... ...............................
~ew Construction ...... Old Or Pre-existing Building ...........
Jocation of Property...~.....C~.~.~.~.; ....... i~ml~ .........
House No. Street
)nwer or Owners of Property..~.'~.~.~.~.~..2~~ .~--... ....................
]ounty Tax Map No 1000, Section.../.~.~.~. ..... Block...~.~ ......... Lot... ~ .............
{ubdivision ..................................... Filed Map ............ Lot ......................
No...~. ff~..~. %...Date
h
'ermit Of Permit...~.w~/. ,.~....Applicant .~ .'-~-....~.~. · ]- ~~.
{ealth Dept. Approval.. ~O~-~.Qt~ .... Unde~rigers Approval .........................
~lanning Board Approval......... ........... · ...
iequest for: Temporary Certificate ........... Final Certicate ...........
~ee Submitted: $ ........................... ... '
.............................................. P ICA="
(p/ease
Z cer=£ty that ~he so!de= used in =~e waker supply system
con=ains iess,=han 2/10 o~ 1% lead.
Sworn %o ~e~=ore me thim
Notary public, ~ C~u~y
Net~ P~bl[c~ State ~[New ~o ~
'ELECTRICAL INSPECTION SER
375 DUNTON AVENuE
(516) 286~6642
DATE: 7/14/99
JUl_ 2:.0,1999
~E3-r
3LD
27337
A~PPLICA TION No. ON FILE
VILLAGE: Cutchogue ~O~v: SouthoM
ADDRESS: Lotli 12 Crown Land Avenue
ISSUED TO; Gendot Homes
INTRODUCED BY: De Lane Electric LICNo: 4354E
was examined on 7-14-99
LOCATION: Base.. x2C )st xX
and found to be in compliance wah the Na#onal Electrtcal Code
2nd xx 3rd Attic
DeL Garage Hot Tub
Pool
SWITCHES RECEPTACLES FIXTURES HEATEP~ FANS G.~L AIR. C03ID.
37 56 37 1-exhaUst
DISHWASHER DRYER CLOTHES WASH. , GAR. DISP. RzhVGE O~ SMOKEDETECTOR
1 1-30 amp 1-20 amp 1-40 amp 7
FURNACE OIL GAS CIR, MOTORS.[BELTRAN. SERVICEDISCOJffNECT
3f '11' J~r~x ~,~s vm,~'
1 200 ug
OTHER
EQUIPMENT
Outside Res.
-. Lk ~.d 'l;whole:hoiige.
1-20 amp whirlpool
1-20 amp water pump
1-hood
~-air handler
1-30 amp compressor
sectionli 102 block~ 07 lo~ 09.00
BUILDING PERMIT No.
BLUE ORIGINAL YELLOW COPY
PINK COPY OFFICE
HUGO S. SURDI
riJl~ll',r:i
EDWARD FORRESTER
Dkectm' of Code Enforcement
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Southold Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
July 16, 1999
Mr. & Mrs. Stephen Tettelbach
134 Moriches Avenue
Mastic, NY 11950
RE: 1530 Crown Land Lane, Cutchogue.
1000-102-7-9.
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
..... not on file. (Enclosed)
No Underwriters Certificate on file.
The check is (not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 24647-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
~'f~Y7c
765-1802
BUILDING DEPT.
INSPECTION
[ v( FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
RaWARKS~~
~-~~.
DATE
INSPECTOR
~~Y7~
-
765-1802
BUILDING DEPT.
INSPECTION
[ ] RO H PLBG.
[ , INSULATION
[ ] FINAL
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS:
~
~l &.f W~
c.Jv-J ~.I~~j
?/crtJfL,. AJ~ Il - 5hd-t /tsl
f
DATE if ftf
INSPECTOR
~
~Y& <17 1:
~ 765.1802
BUILDING DEPT.
INSPECTIO
[ ] FOUNDATION 1 ST
[ ] YOUNDATION 2ND
[vr FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS: No v4u-~ s.>
[1fJ. ~(L (l$~Jt~~
~
[
[ ] INSULATION
[ ] FINAL
DATE ?> ).,~
INSPECTOR
-
""'II
)~~~)~
765-1802
BUilDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [40UGH PlBG.
[ ] FOUNDATION 2ND [] INSULATION
[A FRAMING [ ] FINAL
[ ~REPLACE & CHIMNEY
REMARKS: c9(c<-6'~, -4.k/
DATE IfJ1 'If
INSPECTOR
.
;2C/0f'7 f
765.1802
BUILDING DEPT.
NSPECTION
[
[ FOUNDATION 2ND
[ ] FRAMING
[ ] FIRE~LAC!-'iHIMNEY
REMARKS: M
cO/~
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
.
DATE
WILLIAM J. CREMERS
KENNETH L. EDWARDS
GEORGE RITCHIE LATHAM, JR.
RICHARD G. WARD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-3136
Telephone (516) 765-1938
PLANNING BOARD MEMBERS
BENNETT ORLOWSKI, JR.
Chairman
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
/3,!'! ;, t/0'17+
TO:
John Boufis, Building Inspector
Melissa Spiro, Planner !/It
Crown Land Estates
Lot Number 2
SCTM# 1000-102-7-9
FROM:
RE:
DATE:
February 18, 1998
The Planning Board reviewed your inquiry in regard to the building
setbacks for Lot Number 12 (SCTM# 1000-102-7-9) of the above mentioned
subdivision at the February 10, 1998 work session,
The subdivision was designed at the R-40 zoning density. However, due
to the inclusion of Spur Road, Lot Number 12 was reduced in size to
37,729 square feet. All other lots remained at 40,000 square feet or
larger.
At the work session, the Planning Board determined that the minimum
setbacks for Lot Number 12 are to remain as established for the R-40
Zoning District which is in keeping with the required setbacks for the
other lots within the subdivision.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] RO.~4~PLBG.
[ ].~I~ULATION
[ L/]~ FINAL
[ ] FIREPLACE & CHIMNEY
DATE ~//~~ INSPECTOR ~ ~/~
FOItH ti{).
TO~N OF SOIJTHOI.D
I;U I LD I[HG, DEP^IFI'HENT
'lL'O~d N Il^lA.
SOUTIIOI.D, N.Y.
TEl.: 76.5-- 1802
^ppi OVCd ...... '~../. :-. ......, 19.: .-. Petmi t ........
I',(I^RI} OF IIE^I,TII ,..a/ ...........
,~;..~,?.~ ........................
' c.~,c~4~ ........ ..zz .............
SIr. p'l'l(; FORH . ~ ...............
HOTIFY:
c~u,-3 P$.-. ./ ?._,5. O. ......
. ~..7...--:....¢.7.~.z.. ~ .............
(l~dlding lnSl~ctor)
APPLIrCATION FOIl BUILDIIqG Iq~.IIHI. T
a. 'ibis nlq~llcati¢m n~mt le doq)lel:ely ~ilied
3 set~; of plans, ac~rate plot p'fan to scale. Fee acconhng to ~dtedule..
b. PIo~ plan ~i~' lt~ti~ el lot m~l oE ~ldinga ~ praises, relatloml ]p"Eo ~ljol ~' q proninea or la,bile
c. 'lhe ~rk c¢~'c4 by tl~t~Y~" ,ny
l~ticatiu~ le cemented Im~ore. iastm,~e of ~ildin8 lenntt.
d. Ulxm aR~n~al o( thta'.appllcatt~t, the Ikfildln8 InSlmctor will issue a lkdlding Pennlt to the sppllcnnt. ~k~ch
e. ~ Ixdlding flmll Im ~q)i~ or u~l fn ~mle or in imrt for a~ p~r~se ~mt~er tmtll a ~rtlPicnt.e iff
I~dhli~g 2xsm O~li~ms~e o~ O~ lk~l off ~x~tlmld, ~ffotk
deacril~l. 'llm appltcm~t a~s to cw~*~ly with al.[ al~llcable
rcgulati(ms, taxi to ~l,lt m~Ll~vlz~l jnSlmtOrS a~ p~nises
'' .~ 'o~
If iq~pl icm~t la s cor~ratl~[ sl~ata~re o~ d~lly a~tla)rized of lictor.
(Nme taxi title el {a>rlx)rate officer) '
,.~,.~,,,,,,,,. ~....l..k..~..~~'~;-
l,i~erme
/
I. I~:aL~ o~ lmxl ~ ~[t:h prolxm~l ~nk will I~ ~)~ ...................................................... ~ .....
...... l ~.0 .................. ~...~.'.~ ............ ~ .............. q~.~ ..................
~,,,t~ 'r,~ ~,~ ~. ,~ ~t~, ..... $.~ ..... ~,~ .... .~ ......... ~,,t ....... ~ .......
~l~livi~i~ .,~] ......... ~ ...................... Flied ~l~ ~ ................ l~t .......
(~)
,. ~i,,ti,,~ ,,,,, ,,,~ ,~:~,~,~ ...................... .~b~.. ~ ....................................
,,. ,,,,,~,.~.,, ,,,,~ ,,,,, ,~,~,~:~ .... ~;.~t~..f~.~._ .k~...CA~...~ .~..~..~) ...........
lxx;lll.t: cloarTy mvl dial:loctl¥ a
~j~
'
, ,t ..... ....~.~].~:'.t... ,~¢,, ...... ~.~..
loll
,~,,~ ,,~ ,,,,.,:,,,,,,,, ..... ~j-...... ,,.,,, ,,~ ,,,,,,,~ ,~,,~ .. ~ .~:~,~.~.~..~
,',,j' IH.()T I)IA(HIAH . .
JOYCE M. WILKINS (Slit,mule o~ Alqll il:mil.) '
Nota~ Public, State of New Yo~
No. 4952246, Suffolk Cou~
Term Expir~ June 12,
PLUMBER C'ERT'T'~CAT:~O~!
f~W~ter d~strJbutin9
sy~ tern; P~p~ng sh~ll b~ SOLDER USED IN WATER
o ~ ~e~ ~ ~ L o~ SUPPLY sYSTEM CANNOT
EXCEED 2/~0 of ~% LEAD.
~.~. USE IS UN
~ ~ OF OCCU
~ ~ PROVIOE
' ~ ~ THERMAL SHOC
N.Y. ~ATE BU
P-.EAt~ ELEVATION
~iCY OR
IIFUL
,FICATE
AND/OR
PREVENTING
:NG CODE.
FRONT ELEVATION
OF
LEFT ELEVATION
RI®HT ELEVATION
FOUNDATION - TWO ~
FOR POURED CONCRETE
ROUGH - FRAMING & pi
3. :NSULATION
4. FINAL CONST~UCT~t
BE COMPLETE FOR C.{).
OF
CONSTRUCTION &
NOT RESPONSIE
~N OR CONSTRUCTION
AS TO PAR1'. 721.1
N.¥.S BUILDING CODF.
CL~
Eric Nicosio
REGISTERED AI~C, HITE~T
DR THE
'~ MUST
ENERGY
E FOR
RATED SEPARATION TO
PART. 717.3 (f) (1) OF
N.Y. STATE BUILDING CODE.
~L~A~H ~ESI~EN~E
FIRST FLOOR
pROViDE OPENINGS FO~ -
PROVIDE OPENINGS FOR
EMERGENCY ESCAPE AS
REQUIRED BY PART. 714 OF
N.Y. STATE BUILDING COOL
?/
PROVIDE OPENINGS FOR
EMERGENCY ESCAPE AS
REQUIRED BY PART. 714 OF
N.Y. STATE BUEDING CODE.
414 Ivla~n ~trcef., Port JeFFerson, N.Y. 11-FF/
Tel: (516) c128-445~ l=~: ct28-¢1549
T'ETTELBAC. H ~ESI~ENCE
SECOND FLOOR PLAN
J
SECTION
P.,I~E~ PlA~tRAM
~Y NO'mS
C, EILIN~ It-VALUES FLOOR U-.VN-UE~
Eric Nicosio
RE~ISTEt~E.D ARC, t:IITE~T
SECTION A-A
I
"JAN281999 ~'
//? 7/
I//? 7/
I. '--.' "--/~, ~. 19 jt
"1<""I'''--U.if1.-{j':J.'~'' '99
^1~lroV(~I... ......!o..... 19... f3
nisapproved ale
PClmit
2- ~'ti2 h
No. ................
1I0^RIl OF IIR^I.TIl ...............
J SRTS OF PI.^NS . 0 . 0 . . . . . . . . . . .
SI1RVRY 0 0 0 0 . . . . . . . . . . . . . . . . . . . .
CIII!CR .0.0.0.0........0........
SI!rnC FOllH .......0.0.........
1I0TlFY: f'l'.~h--, (',i ll',os
(~~\?o':\-:~'.l~),... .
~t^lI. TO'..... o. 0'"" . .. . . . .
.
l'OllH 110. I
TOWN Ill' SOI1TIIOI.1I
IIUII.IlII1r. IIRI'^,r11mNT
TOWII 1I^1.1.
SOI1TIIOI.IJ, N. Y 0 I 197 I
TRI.: 765-1002
"
.. .....Ic~."u~u~n.~u~.~...t(~~
. l' ,-, 1.. n I
'II, , \..." . :\; \! I ^I'('I.I C^T1 ON 1'011 111111.IIINl: ('IWHIT
ll\... I') tJ lIate.. .?-:b......... ,19.7'.{
L__._.__ I NSTlIl1CT lOllS
SLDG. DEPT.
JOW OF SOUfliOLD
n. "hi ...opphrn M! co,..) elely filled in 1.y lypeHdter or in ink nt.1 mlhnitted to the IklildillA JI1SfX!ctor" 'lill
) f',(!lR of plnns, aCC\lrnte plot 1,lan to scnle. Fee nc(:onHng 1:0 Rchetlule.
h. Plot pl811 showiug location or lot nnd of blildings on premises, Telntionship to ndjoininR prewniReR or ....hl ie
!lln~.(?tn or :JI"ens, mx:1 givinn n delniled def;(~ription of Inyonl: of property n1lst be drmm on '.he din"rn" whic:h in "'tnl or
lhiR nppl icntiOll.
c. 'llIe wol'"k covered hy thiR npipl icntion f'lny not he c(Jn'~ncf'(1 he fore i~su,Ulce of ",Iilding Permit.
d. Upon approvnl of thin npplication, the nnilfling lm;pector l"ill iRm-e ~ nuilding Pennit to the "l'pUI'nnl. &If'h
permit Rhnll he kept on the (rremineR IIvnilnhle for inspection Ihn"lf~lOtlt the lol()rk.
e. No '''Jildinn rdUlII he oC(,lIpied or ufl(!(1 in \.AMII". or in ''1:1,.-1: for. nny f1uqxme 1oAmtC!ver until n (:.erl.irh.nlp. or
Oc~:"pancy sholl hmre heen nr:mted hy the Ikli hlinn lTmpector.
^1'l'l.ICATlffl IS IErumv ..Wit to lhe nlli 1(linn l~p.'1rl"ellt for the iRsunnc:e of n nui hUng Pemlit ,_In.",""l to tile!
fil.Jilflillg 7.one Onlin1Jnce of IIIe Town of &Jl.ltlwJld, r~lrrolk fA'P.lf1ty, Nc\" Yo"'{, nnd oIlier npptlcnhle T.owR, Onlinnncr~1 or
Hegulotions, for the construction of hnildinUA, tMldition9 or nlternt:ioIlA, or for renuval or (km11 Jtion, nn hf!rein
flescril>e(1. 1~le applicant "weeR 1:0 cOllflly with 011 nppllcAhle lRWA, onlhVl1lCe9, huilding code, hOl.u~lng cocle, nnd
r<'!U11lotionn, oiKl to tll.hit lJulhori?ed irmlJeClorR on premiReR nnd in hl.Jilcl~np, r .""ce..nry Y~don.. .' ._
~h:~c. "~(?{~'':-./.)$4t.XtJ.f!:el.tl3;
(~ig' lure of nl'plicnnt, or nm~, if n ccn-po,-f1tion(
fY:.f!?C!X /'l:-fP.. .ql!.+:!-.l.~':P:~. .~y (/9.?7!'
(No"I 1 iog 3C:tl:lrenR of nppl krnd:)
Stnl.e \oAtellM'!r npplir.nnt in OW1'lf'r, Icnnee, "W'lll, nn:hi1rct, r>n,~il1(!er, p,rnernl conlrnctor, eleclricjnflMIIJ1h.:~r or ,"Ii 111(>,..
./J~.... .......L;I~ p;;;;. ... ..1,.. .....~. ................ .~~..'1~~
Ill..., nr "'''''''1' or (>mlll",," .................. .~.I..r ,. hI......................FfifI: . . t. . n" ~ ~
(no "'. Ih" Inx ...11 nr Inl.e"t "e",)) NonPY -.DING DIMII1'MI AT \I
If nppl icnnt in a cor-pornlion, nignrllure of cllIly nll(hori7.(~<1 officer. '781-1. . All 1O:.J': FOR THE
'-1 -iJII.larK,.
,. POUIIWIIGII . 'NO UQUIRED
I'0Il10..1111 Cl)M....
I. MJU.' ..,- .1. JIWMIIING
I. lNIUUI1CJN
... FINAL - CONmUC'flON MUST
IE COI'M.I1'I POll e.o.
ALL CONSTRUCTION SHALL MEET'
THE REQUIREMINTS OF THE N.Y.
STATE ~STRUCTION . ENERGY
011",1' Trade's I.icen"" !lc,. .................... ( c =1. '~_R_~~PONSIILE FOR
I. location of land on .A.ich propo""d wnrk will be rkx",..o.re3.~.Rd...~.......~~~.~~~.~~~~~~
...??\.9. .?.... Q.~ .~~.. ~:......................... finlli.M(.. 0..............................
Ih,,,,, tb1ber Street . Ihlllet .
thnlly Tax ""(> !lc'o I!xx) Section. q.?~.~.. IlIr>ek ...... (, __.... __ Illt 0.. .~........
.........................................................
(N:IIlP. ,IUd title of corporate officer-)
I\ui hJenJ License No.
P1111hers License No.
Electricians To'iceru;e lb. .......... _........._
&Ilxlivision ......................__.............. Filed "\,,,1' No. ............... Int ...............
(Nm-e)
2. State existing \JRe and OCClI(l.-1nc:y of In.emi"*!n mw.1 illlf>l'wlNJ \me nlxl OCC\J~lK':Y of propoRe(' con9tn.lr.tiOll~
a. Existing n.., am OC(~Jl"'ncy ..11:/'XJ.!ld.dl.1-f.d.. i ~l,.., ..QA(~-p-C(((:...... ... .. . . ....... __ __ __ __ .. . .. .
h. I nter.led """ "nrl nccup'nq __ :Qf?0'!. p./ (f/ 0:L __ __ .. .. .. __ .. __ . .. .. .. . .. .. .. .. . .. .. . __ . .. .. .. __ .
r-, .i; fl'
,'.r..\! \'<~ ,.~, ( ,. ;' ,~:. "l'~1
,111\')-') xi, \1;';:' rll: 1: If- :U
(; f;' ,~.. i t' " ,. j (. , l'
___~._.rt'f.n f.'! "f,;'d ,r".r
~
-
"
'I.
tJ~ltlHC of w(uk (dM...'"t:k \Jakh ap(llicalJl~);
Itcpilir ............ Itf:uoval .............
l'i..-"\,I UuBtlillU .......... Adtlition .......... Aheratioll ..........
I I.. vV' I
leul.) IllOIl ............ 0' ler \kuk ..................................
(Ilescr ipl i,",)
to.
liSllo...lc,1 Cost: .$. !9./. {!>.~.9.:-:-:.....
fee
(to he paid 01.1 fit iug lhis uppl kUlion)
~). I t ,L~ll inn. u....>er of d...e1linU IUlils ...\......... ll.uher of ',,"-A.:d I tug lu.irti ou eOLh floor ................
If lluruUe I ....j>er of can. ......................................
6. It husiocti8, aJ:nllfH-ciul or mixed occlIpdncy. Bpecify UiJl.ure aud cxtcul of em:h lype of use....-::................
J. lli""""I,",,, uf exi"Llll8 "lruelul"". if W'Y' l'''.,l................ lleur ............... llepth .................
IlciWll ......................... tl..tJot:r oL; Sa:ocies .. .~k................
ninleutiiul\s ot sme ullucture wiLl. alterations or additions; F'rOtlr ............... Hear ...............
lk.!plll .................... Ueiglat .................... tl.lj~T of StorieH ...............
II.
UiUlClltiiouti oi: elllhe new cousuuctiou;
Front ................ Ileur ...,........... Depth
I~il~.t ............... _......... tillher of Sl'orietJ ................,....
9.
Siu: of lot;
ti'IOIlI[ .... _.. _............ llt!ur .................... I~plll
10. IloU e of l'ln:huue ..................... Ni,,~ of Forult!r (~..er ....,...........,.......................
II. UM~ or UtiC dlsld(:t in \Add. pnlllllses are situalett ...........................................................,..
12. lk",.. IlCol",""d C...~lrucll()(l vlo\ote OilY ","II1IlI"". ordillo"ce or <elllll..llo<l: ........................
u.
Uill lot he leuruded ..................'.. Will exceu8 fill be rellloved hUll pn:lnise8: YES m
N<."e" of I",,,,r of p"..1""8 ~l.~. ~~. M'~r~..... Iwklr""" .1Nt!..'....... Jf............... Pholle lb.
lit.
ttllllC or An.:hiLect .................................... lv\th-cti8
nlOOe lb.
Nillle of C..otlLraclor ................................... Iwldrestl
11.
I. Ihi. I'mperly wilhl.. ](X) feel of 0 tidal ,,,,,Uo,.11 * YI!S ..........
'I~' Y"S. ill/mIll 'IUll 'l1aJSIIiI~~ 1'Ii11l11T BI\Y I~! 1CE(~lIlUal.
.............................. .111000 lb.
V
tn ..........
l'I.O'f' IIIAGIlI\B
liX:ute dearly and t1iBtlnctly all buildings. \Atelher c.xitil.ing or proposec.l. flud indicate all set-back din~nsion8
frOll plol.erly linea. Give street and block ..II.)er or (lescriptioll acconJing to deed..and 61KJ../ street nol~8 and irMlicnte
\./Ilclhcr intcdor or cornel'" lat.
~ /ll/ada.c~ !
OlTOII 2A OlYOI.U
.~..
:VI :liI'I
TA TM3MlJlMJO (lMIClJlU8 ""110M
311T IlO'I M'I .. Of AlA. IOIt.P,
:a~II~II()"
O:lIlIUOllII 0W1' o~' t
1,_ all_1CM
L11110MUJlI. 'I'~M olflUC)Il .S
MOnlUUaMl .&
:;I'A!lIl'.lfo'NGITOUlIlT'1403 . JA14I~ ,~,.
7121 IN'Y.llIl .O,~ '03~~ "'27
- UM '.].JAlla )"CllT:N 03 J.Jo\ L..' . S'
tl 'I /2 3M ,=rlft<!'
',.,. ~ '3~)1Jj.TfJ./f::o/.......I.';1I1l duly
(N;ilil 01 Jhkl'il401' tllill'dllk <.:iDIl(IJ;:))
"1.,,,e'ulald<l?1 r:JUIi r..'1'10J fl() 11C>lcna
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b"hltJl-U. depOtillB nUll HUYS Lhut he is the nppl kwH
((;ulIlII)(;
I. (:orl'ofute offkcr. el c.)
Ikl iu th,~
uf Hai,1 OWllef or (JWI)(~r9. WM is duly uUI,horiu.-'t1 10 IlCrColI1l or hwm I'Crhnlll~(1 tht: unid work LlIM.1 to uul(c WM.I fi Ie .hill
uppl It:lIt.ioui Ihut nil t1tUIl11~lIlH cOlltuilM:c1 ill Ihiu uppl kul iun an~ tlllt! 10 the hent of hiu klM.PrlIc..-'tlne uud I)(il.it~r; ilud
Ihal. the \.J\Hk will I)U perJ'ullI"'-'t1 in IlK! IlliUII.e1'" set forth ill llie ilPlllieal.iuH filecllhen.-'W'ilh.
:MH II lo h(ll'mc II.~ Ihin
5.&.
. . . . . '" . . .. ... . . ..day of
ItHilr-y I\d)l ie .....
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(Slgllat:\In~ of ^llprH~HI\t)
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