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Home My WebLink About18752-z~ 4 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20272 Date OCTOBER 9, 1991 THIS CERTIFIES that the building SWIMMING POOL Location of Property 860 WILLOW TERRACE LANE ORIENT N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 26 Block 2 Lot 47 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 24, 1990 pursuant to which Building Permit No. 18752-Z dated JANUARY 24, 1990 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 PIERRE-ANDRE GAZARIAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A CERTIFICATE N0. H-024717 - SEPT. 30, 1991 PLUMBERS CERTIFICATION DATED Building Inspector Rev. 1/81 A . y rosat xo. s 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) N~ ~ Z Dote ... ~~~~ ..................................... 19.,~(,,,{7J ~.~7~2/ ............. Permission is hereby granted ..~a....~~...~ ..................................... ,~p,~~ (n /,J / .................................................................................................................... ....................................... . / ... of premises located at .....S.r.~Q......6r/.... ..c~l.'.:..~.,~.tJ..`(.~... .~1~ :................................ ..................................................d~~..................................... ........................................ County Tox Map No. 1000 Section ........~...~a........ Block .......,~:......... Lot No........ r'~....,~~....... // ~Lw f pursuant to application dated ...~.~~..~J..,~.~..~ ................ 19.~Gtd..., and approved by the Building Inspector. 11 Fee $.•.1.~~...~ ~~~y~~~~~~~ .............. ... ........................ Build t r Rev. 6/30/BO ~ o a FORM NO. 2 TOWN OF SOU,THO~.D' " BUILDING DEPARTMENT, TOWN CLERK'S OFFICE ` ' _ SOUTH'OLD, N. Y. BUILDING PERMIT i (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o ~9cg~ Z Date .....:................ .. .. t,~......., 19:.~': Permissionis hereby granted to: f a ~,f ...,~~^^ f :/V..: i:~:?f.~~;:r. ;<..... ~....4cS.!:5ua.r ,;,C.fi... ~??..G'---- ..... to ...~.~:j f:. ~.........1.~?.......,-~~,. Garr r~'!~~~f i !J.<....... t Do ?;.. .1~".:'...~,f~a~..l~I ~;.~:........:. .................:.....................................................................................:;........................................................ ' l/!~ / ,~ L 4 W T,~ h' f;~ti C` k~' L_ A N k at premises; located at ............................................................................................................................ ....... ..... -y .......... pursuant Yo application dated ... ~.~~ f~ , 19.1. ~; and approved by the Building" Inspector. -- Fee $....:' .............. v' b3H10 NOLLJf1211SN0~ bbll3J NOIlO(1?J~SNO~ IOOdSS?O N0117f1a1SN0~ J,VM3ARI(] 101 JNI:7VU`J3N ~J.e S3SIW3ad 3~Oflt/ W02fd llld SS30X3 7~OW3b Ol . I~fAObddb 574~11~N1 lIWi13d ...y ............ .». .. .............. 'Building.lnspector. .o Form No. 6 ~=f'~`~( ~ P ~ "C~ l ~~ TO[dN OF SOUTllOLD , BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFTCATE O1' OCCUPANCY 1. This application must be filled in by typecariter OF, 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 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 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 Che building. 6. Submit Planning Board Approval of completed site plan requirements. :S. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-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. 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 Euilding - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4, Updated Certificate of Occupancy - $50.00 S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Dace /rJ: ~- ~ / ............................. ::ew Construction........... 01d Or Pre-existing Building.: Locacion of Property. ~'6.°, .... (^!/c ~. ~ w .. 1.~~~ ~`......i .......a/~/c-wT ................ House No. Street Hamlet unwer or Owners of Property..~'.~~.r:.~`.~..,CAz_,A-jc'i.,9-~/ .................................... r:ounty Tax Map No 1000, Section.. z: ~.......Block...~Z.-:..........Lot..~.~ .............. Subdivision ....................................Filed Map............Lot...................... PermLc No.. (d'~S. Z; . 2...Date Of Permit. ~. ?..~. , % o, .Applicant.~.~~Rr . G f}-'Z A-~l i.d/-T/. , lenltl~ Dept. Approval ..........................Underwriters Approval......................... 'lanning Board Approval ........................ request for: Temporary Certificate........... Final Certicate........... 'ee Submitted: $.?.~~ .............. eo~ada~~, APP N~ VICTOR LESSARD PRINCIPAL BUILDING INSPECTOR (516)765-1802 FAX (516) 765-1823 ,~''~fFOLkc`~, ~~ ~ ~Ol ,~ ~`a~<- OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD January 10, 1990 Mr. Pierre Andre Gazarian 20 Beekman Place New York, New York 10022 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Re: Building Permit #5981-Z 860 Willow Terrace Orient, New York Suffolk Co. Tax Map #1000-26-2-47 Dear Mr. Gazarian: In reviewing our records, we find that a Certificate of Occupancy for the above numbered building permit was never issued. A final inspection was made on August 9, 1988. CO was denied because the swimming pool did not pass the inspection. (See attached copy of inspection ticket.) This building permit is expired, and a new one is required. According to the Code of the Town of Southold Chapter 100-284, it is unlawful to use said swimming pool with a Certificate of Occupancy. In order to avoid legal action, you must contact this office immediately to resolve the violations. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Gary J. Fish, Building Inspector GJF:gar encl. (Cert. Mail) hu~~Fz~ THE NEW YORK BOARD OF (:IRE UNDERWRITI_RS ~ sultewu of EuecrRlcm 68 JOHN STREET. NEW YORK, NEW YORK 10038 SF.Y?'rlifAN:k .9f~ 7447 74(192'~r-3k/41 H Oa"ili Pa<;:; Oob ~ ~ Appltcatlon No. on file TH13 CERTIFIES THAT onty the electelpi puipmsnt w deeeribed 6elote end Introdund 6Y the eppticent named on the •hotAS eppNoetbn nuwMe iw Ike promleee q/ p;. b;itNF Gp7.ART~AN, h6u NTJd,O~! `iN:kNNI'i'., nH!b;~Y'C, IV.Y. ~- inthefollorelnRkrca~~iiQrn~~' ^ Rqe /Kt FI. ^ Ynd F1. ~)u~i~ Section ~ BIOCk~ Lot ~~ mee a:emined on and found to be in compliance with the reyuircmentK of thL Boerd. NXi1NR t111T1RTS ACIK fW1TCllRf MKANpECENT rlUOENCMT OTHER RA AMT. N6Rf K. W. COOKI-1 AMT. 0ORf:.KS K. W. AMT. [.W. AMI. K. W. fXNAU AMT. ST fA1K R. 1. IN1YMf Rlwu-a i1ROTORS t~tTURe AI711ANCR IRROUR SrRtIAERRC7T TIMR rEOCRS RRtt 111111 tfMTas klu[T-ouTwT OYAMlRS AMT. K. W. dl K 1. OAK H. r. AMT. NO. A. W. G. AMT. AAV. AMT. RAVE. TRANS. AMT. M. r. ~, p ~t NAt. WAIrE fMRVICR OR180SIN1t.T No.a S R R V I f L. - AMT. AMA. iM4 ~ p O, I /'IW 1 / ]W ] / TV ] / AV NO.O~C,COND. A.C. COND. NO. OF nAEG A.~ O. NO.OF NEUIIIAtS W mYT4L v~nsw MRwenrYK sxrr~mznr, Moot,-~+ *NO VISUAt, llFNS:<"C:: "An el vCT ri;7R; survey has iasen ~~ ads, of the expo:;ad elartrieal. equiprnw~,r in the premises indirar~r' °No oiwjoote, Ut1F0 Ci.9f tart OCy PhCtni(, i.n^ Wdfl fI;IUYu~. Pi.F.FK"r. i.p%:AH%AN P.O. H07i °> ~ 7ME.arlNkotX nIW not W oNerd in qtly monMr return t0 the E _ COPY FOR NUILDING DEPARTMNNT. TENS COF ~~ •[r~ MAt tlA/1AM _ P~ ~ 1 ~ V incomcf. Inspeclpn m4Y be itlMlli~d by tlldr cndeMiob. , , _ OF ,4~'IETiRICl-TE MUST N07 BE ~ n ~~~~ . 2 ~~ C~~ ~~~ 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ] ROUGH PLBG. [ ] Ij~ISULATION [ ]FRAMING [ FI~~ REMARKS: //~W~. ...~.- ,(Y p DATE U 6 ~ INSPECTOR 1ELD Ii~S.'Fr.CTIU~d (4 llATG ~ COMMENTS 1 ,. R rOUtJDATION (1st) c N FOUNDATIOtJ (2nd) ~ 2. z ~ 0 s O ROUGH FRAME & .PLUMBING ~ ~ H ~ 3. ~ IIJSULATION PER N. Y. ~ ~ .3 STATE ENERGY C CODE x S ~ Q r 2 ~-~ H ~ . a F I;J A L ~Z ~~ { ADDITIONAL COMMENTS: 5=t • / ~~ p _ , • /~ ~ ~} x w H 77 ~~~J/~ H ~ O 2 . ~ 9D - ~ x ~ f -- . d ~, b H ~. FORM NO. t TOWN OF 5OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 BOe1FD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY .............. CHECK ~.JJ.'~Y .............. SEPTIC FORPI ................ NOTIFYa /~ TEL.: 765.1802 CALL ~........., 19%'~ MAIL Examined / /.1 • ? APProved ..,~,/a.~......, 19~. Permit No.~~.7~a~ Disapproved ale .........................~~'O.G?'~!j~r~%Ghr~.J~~/~ ........................'1 [~~.T ~~ . -... ...uil~. Inspector) ~. "IMMEDIA ENCLOSE ppOL'1`O'CQ~EgPPLICATtON OR BUILDING PERP~IIT ...a~:~:z .......... . Date .jf Z ~".-....., Y5/ 0 INSTRUCTIONS • h,; a. TIus 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 riving a detailed description of layout of property must be drawn on the diagram which is pan 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,pr used in''w`hole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted~b,Y.the Buil`ding`Itispector. APPLICATION IS HEREBY MADE to the Building Department for the i; lr~~ilBuilding Permit pursuant to the Building Zone Ordinance of'the Town of Southold, Suffolk County . , di eta d other applicable Laws, Ordinances of Regulations, for the construction of buildings, additions or alterati~is,or !~i ` hE~'~oval or demolitio as herein described. The applicant agrees tb:comply with all, applicable laws, ordinances, build' code, housing cod nd regulations, and to admit authorized inspectors on prA3nises and in building for necessary inspe 'ons- ~ ,~ ~c~~.~ ' '` . - (Signature of applic , or , ~ a corporanon) "t • ; ; .,,; ; ~ (Mailing address of applicant) State whether applicant~is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Q rti Nz~IL.. Name of owner p,( Premis0s a~`fL ~ 2 e=-, G~~ Z ~I~~'~ ....................................... . y N 1RN =•s'' +"'~ 5: ~ ~ (as on the tax roll or latest deed) 4r~j t''i is ,'9~'~i'i .': If applicant is a ~9rr~~r~tion,sig~alpre gfduly authorized officer. .............................................. (Name and title of corporate officer) ' Builder's License No . ......................... . Plumber's License No . ....................... . Electrician's License No . .................... . . Otltcr Trade's License No . .................... . 1, LocationVOf/land on which proposed work will be done; - ... r... .......... ............. House Number Street. Hamlet ~ ~ •• County Tax Dtap No. 1000 Section ...? ~ ...........: BI'ock .. , , ~, , , , , , , , , , , , Lot .... r ~ ..... '~ , , Subdivision .............. .... .............. Filed 6lap No. .............. Lot ............ . ..(Namej ~ .. :. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ,//~jj ~ _ _ a. Existinguscandoccupancy.Y.:~~•r,•~~~~~~••••••••••••,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,• b. Intended use and occupancy .................................... ............................. . t~l; 3. Nature of work (check which applicable): New Ouilding ... ~ , . Addition .......... Alteration . , . Repair .... ....... Removal ............. . Demolition ..............Swimminc~"1, , , , . , , Tennis Court ......... Accessory Building..........Fehce .......Other Work:.......:... 4. Estimated Cost T,W:a.../:~r;!!V.Z?1~~'??...r~,UT.CL o2h-... Fee ................................ ... ' (to be paid on filing this application] S, If dwelling, number of dwelling units . . ............ • Number of dwelling units on each floor ......... , ...... . IC garage. number of cars ..... .............................. ............................... . 6. if business, commercial 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 wit ' alterations or additions: Front .:.............. . Rear ........... , ..... . . Depth .................... ~ Iicight ...................... Number of Stories ...................... 8. Dimensions of entire new constntetion: Front ............... Rear .............. ,Depth ............... . Hci~ht .... .. . ....... Nutnba~r of Stories ............................ .......................... . 9. Size of lot: Front . ~ _ 10. Dateof,Purchase /(!~~,-,&~,~,;^,,,,,,,,,,. 7"~~C~ .,_,... •. . Name of Former Owner ' ..~. L~:?ti , ,. }, -1. ?one or use district in which preipiscs arc situated ...................... . • .. ,,i, • ........ . . lam. Does proposed construction violaCe any zoning law, ordinance or regulation: . !"~:°...:.:~, ... ,'..,i..~.......... . I3. \Vill lot be regraded ... N.. ? ' Ni11 exc ss fill be removed from premises:. ' Yes . No . . 14. Name of Owner of premises .~/~'2!L~; ,•~~;!- ~~ (r~ddress ~:~•. !~.°.?`: , . ~.. Phone No..?.4>~ ~r.~6. , .'. Name of Architect .......... .... .......Address ...................Phone No................., Name of Contractor . .Address .. .. ...... ... ..Phone No.. ...... . IS.Is'this property located•within.100 feet of a tidal wetland? *Y);5..,'aNO.... *If yes, Southold T6wn,Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. - I ., ~EM~ED1gr~CY•• . uP ~ooL r ~~~~ 9E ORE WATER N OE ' ~~ ~Qfl1R~1CigE I AP,Pk01fED AS NArFn . DATE:.- fr--~f~r.G.- B.H ti ~`5 2 766-1802 £1 AM TO FOLLOwIN(; INSPECT t, FOUNDATION - ' FOR POURED CONI 2. ROUGH - FRAMINI 3. INSULATION ~~h"'+ 5 Q. FINAL - CONSTI ~~1 Y BE COMPLETE FOR ALL CONSTRUCTION ~~ ~ ~ ~g~0o. THE REQUIREMENTS ~~``°° STATE CONSTRUCTIO ~~~~~~ ~~~ CODES. NAT RESPI Uc?SIGN OR CONSTRUI ~~ ~9 ~Y STATE OF NEN YORE, .S COUNTY OF~/~.~.~.~.......... . • • • • • • • • ~ • "` • .... being duly sworn, deposes an • (Name of indiv' ~ .al in ~' ontract) . • ... above named. Ficisthc .....................i .... ..................... ..... ... (Contractor, agent, corporate officer, etcJ of said owner or owners, and is duly authorized to perform or have performed the said w application; that aI[ statements contained in this application are true to the best of his knot 1 work will be performed in the manner set forth in the application filed therewith. ' Sworn to bciorc me this ' .............. a.~ ......day of .. ..........., 19 .qQ f ''/ Notary Public, ...1..,A.•. , ~: ~ ...... County ... 4'.. , .. HELEN K. DE YpE ~ NOtARY PUBLIC, State qt New York No. 4707578, Suffolk County term fxnires March 30,19_._ PM F~ THE NS: VO REQUIRED ffi PLUMBING MUST SHALL MEET Of THE N.Y. v !~ .ENERGY INS"',3.~ fOR ,7'ION ERRORS says that he is the applicant and to make and file this gc and belief; and that the i` 91.127 gnataune of applicant) FORM NO. 1 ~: TOWN OF SOUTHOLD BUILDING` DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~- ................. ~......... ...., 19..7... Approved .. ~ -7 ~Z~ ~ ~/ .............................. 19:....... Pemit No..................................... Disapproved a/c .............................................. ......... ......................... Application No. ~./..:.< ................. ............................................................................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..:............T../.....3y~...., 19.,7 INSTRUCTIONS a. This application must be, completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale: Fee, according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn oh diagram which is part~of this application. c. The'work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the, Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for irispectipn throughorit~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 grariteii by'the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for .the issuance, of~ a` $uil~ding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lavys,;Ordinagces or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees fo comply with all applicable laws, ordinance;, building code, housing code, and regulations, and to admit authorized inspector;,on premises and in buildings for necessary inspections. ~ ~. ~- .- ,. . ~- ., .. ,^ ... , ~~ (Signature of applicant, or name, if a corporation) ^ ~ (Address of applicant) . , State whether applicant is owner, lessee~ag~Qnt, architect, engineer, general contractor, electrician ..... Name of owner of premises ....... ..~.~,,~rF.~r~.-e.-^-,~~...... .... ........ ....r.~..:........... If applicant is rporate ignature o duly authorized officer. ....... ..... .. .... .. .. ..... ... .........:..::....... --~.n --e (Name,~and tle of corporat fficer) n plumber or builder. 1. Location of land on which proposed work will b~e~One. Map No .:.......................~.........~......... ..... Loot No....,1..... Street and Number ......~°.~.:!~..:4%~ ....................... .....:........ ...d....~lN.Pr.Ef/.~..~..:~ unicipa ity 2. State existing use and occupancy of premiseHs/and intended use and occupancy of proposed construction: a. Existing use and occupancy ...............'F~~/JG.?-~..........:.:....................':............................ b. Intended use and occupancy .............GJ..~!1n,:G.....~~....~......: ................ ............. _,` ~ , '~ ~ '"e 'i ~ ~ ti Re air ................. Remopp4icable): New Building ....................... Addition ................,... Alteratio ....... ~~ 3. Nature of work check~~wlhic ~ ~~ cription) p .... val .........:............... Dem ' ' n ........................ Other ork ........... ..`o~'a.H;:• 4. Estimated Cost .. ~~.....;iJ.~ ~....r..tR:.61........ Fee .....%.S r...l~:'A .................................................................. Ito be paid on filing this application) 5. If dwelling, number of dwelling; units .......~/....... Number of dwelling units on each floor .........,/ ............................. If garage, number of cars .........' ....................................................:.............................................................................. 6. If business, commercial 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 ............ Number of Stories ......................................................................................... 9. Size of lot: Front ...................''................... Rear .......................................... Depth ................................................ 10. Date of Purchase ................. p ~~~. Name of Former Owner ....~-~~..-.-.-...A~,/~P:~~ ' ......... emi~ses are situated .........b~......r-~k+..Y...~: ........~M. .... ~ 11. Zone or use district in which r ~], 12. Does proposed construction violate any zoning law, ordinance or regulation :.............."/,f...ll..................................... 13. Will lot be regradedp....._._.. Ilf .............~..... Will exc~}ss fill be removed from premises:,[ Yes [~ No 14. 'Name of Owner of remises ..~.~.4arl..... ~!.~:~~..'.~.~'.S ............................................................... ~%A f'IAddress) (Phone No.) Name of Architect ......... ....J :..... ........................................................ ................ .......... ................. ff dress) ,/~'~ ~/~(Phone Name of Contractor ~i.., .~ ~r..t..~ ...:..............`~?.r.LAG:~-o.~nl-R!-P...:v`~G.~1..°.p'~' IAddress) (Phone No.l~ ~, ~. PLOT DIAGRAM 92~- Locateclearly and distinctly'~all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines, Give street and block, number or description according to deed, and show street names and indicate wheth- er interior or corner lot. i ~o..~ , ~= STATE OF NEW YORK, ' 1' ~ /~' ~/V F!~'~.p / h`.o ~ s ~ pda,L ~f ~ >; i ~;: Srm ,.~„- ~~.,rw~ COUNTY OF .........,../ ...................................1.....:•.1 ~~ ~ ~~Name O tndiv d ~s~~~~~ ~ "" "" being duly sworn, deposes and says that he is the applicant above named. ( `' f gri,'~neg_.c~ontractJ He is the ..................C:r?.1,~L.r ~frO.:z..........'.-"..... ...... ..... ... .................~~.. .. .....,............................................................. ,.r1l4.rR.... (Cent ctor, agent, corporate of er tc.J of said owner or owners, and is duly 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 manner set forth in the application filed therewitFj. .N~ ............................... .........................................:.............. 19..........x.. / `%^/ .....tarY Public, ........... day of .................'........................... County ...... ............... ....:.~•.• ........ ........ .... ........ i (Si re of appiicantJ