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HomeMy WebLinkAbout17186-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25157 Date JULY 25, 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 3315 WELLS AVE. SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 70 Block 4 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 27, 1988 pursuant to which Building Permit No. 17186-Z dated JULY 1, 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate ie issued is INGROUND SWIMMING POOL WITH DSCR AROOND & FENCE TO CODE CODS AS APPLIED FOR. The certificate is issued to CAROLS M. RORS {owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-027513 - AUGUST 12, 1988 PLUMBERS CERTIFICATION DATED N/A Building Inapecto Rev. 1/81 FOSM NO. S9 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) Nfl 017186 Z Dote 19..~.~ Permission is hereby grantedpto: , ~ . ~'f ro ..~:%!rw?31^:4s~......min....~-i~j~!~^~8!....n~.~:..,~,,,,'r!.4?-.....ci'°....~.,/1, ...V . . 1, at premises located at ..3~ ~ 5.....!~R.K~A~ County Tox Map No. 1000 Section ......Q1~....... Block ......Q.~........ Lot No......~r...g pursuant to application doted .r1..-...~ i9.4~.., and approved by the Building Inspector. Fee $.~wS.V....~.... 'Building'Inspector ' Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewer. age-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 17 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey oI pr.operty showing all properly 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 Euildine - $100.00 3. Copy of Certificate of Occupancy - .25C 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date JULY 22, 1997 ]ew Construction..?....... Old Or Pre-existing Building ,ocation of Pro ert 3315 WELLS AVE. SODTHOLD, N.Y. P Y........... House No. Street Hamlet •nwer or Owners of Pro ert CAROLH 1~{., ROKE P y ounty Tax Map No 1000, Section.... ~~........Block....!+...........Lot....8 ubdivision ....................................Filed Map............Lot..........'::........... 'ermit No..:L7a`1$4^4> .1,;;¢; .Date Of Permit. ~.~1.w88.........Applicant.. A., REILLY, SON,,, INC,., , , , , , ~iealth Dept. Approval ..........................Underwriters Approva1.N027513.- 8/12/88,...., Canning Board Approval . equest f.or: Temporary Certificate........... Final Certicate..~...... ~ee Submitted: $......2.S,:AA ~ 3 ~ TJ ......CAROLS ROKE ~°Q y`~ 151~~ APP7.7 CAN'P _ ' fir. 2 $1937! e ~ `C1~ n. ,a? 214-64 32nd Road Bayside, New York 11361 July 21, 1997 Building Department Town of Southold Main Road Southold, New York 11971 Att: Georgia To whom it may concern: Concerning my telephone conversation with your office this date, I am enclosing an additional check for the sum of $35.00 to cover the cost of inspection of my deck and fence around the pool at my home which is located at 3155 Wells Avenue, Southold, N.Y. I understand a final inspection will be scheduled for this coming Thursday or Friday. I appreciate your attention to this matter. I remain Sincerely yours, Carole M. Roke Permit #171862 THE NEW YORK BOARD Off' ~IftE UN'DERWRIT~RS PAr=E 1Q01.3A1 e ®UREAU OR ELECTRICy~ITyY AUGUST 12., a.98ifa JOHN STREET. NEW YORK. N~644 j~$3@ jj Oa7513 ~r° Date Application No. on file THIS CERTIfIES THAT Gv only the alectriwl equlpmewt o. daecrihed 6sknD and introduced 6y tM appllcont tNrwsd aw the ahooeapplicotkKn numhar In the premiaee of 0 RF.RT ROKE, MEI.1,3 AYE, POLE ~NyTli, SOIiTNOi,D, N.Y. nilT in thefollou~inp lnco~~ ~ ~~sent ? IAt FI. ? Ynd FI. Sertion Black Lot reaK examined on ~ and found to 6e in complionee ui4h [he reyuirenleRiteuf this Bwrd.. • MRIEIR! EA ~ CYOKNI6DECKS RXMAIKT . tIYT1ETS NS ~T~' ~ NCANDFSCEM PlU0RE8RM AMT. K. W. AMT. R. W. M1T. K.W. MR. K. W. AMT. M. P. 1 1 DRYERS RIRNACR MOTORS RtTYN AlKIANq IgaYf AL MC'R TISIlGOdti W VIMT IAAitRii SY57KTt•OVIIlT DYAMRRS AMT. K. W. Oll N. P. OA6 N. I. AMT. NO. A. W. D. AMT. AAV. AMT. AMPA TRAMS. AMT. N P. 1b. D~ RRT AMT. WAT16 ` 1 I ~C SM1RQ OpCONSiRCT ND.OF S ! R V 1 G E AMT. AMP. TYPE 1 / 7V/ 1 P 7W 7 / 7W 7 / MV NO.O~C COND. Af~W~ 6. NO. OP NF1t6 Of NO.OP NEUTRA1b Of . W. O111N AMMRATYS: c.r.c.7:-1 *(SWIMJKINC, POOL} This certificate covers coElgliance a.t the date of insgectinn only. Aecause r7f unut7ual - envi.ronrments i.t is advisable er, Ei~ have frequent, test/and or repairs Ig~de by a qualified gersT~n. .cr~ .JOi)Y PTIM71,l.r) - PAT ?,ANE ~ MATTTTIiCK, NY, 7.195?, 11 MARIItiRll ~ T,1'!"ENSE NO. 23()0 E Per ;This artiikaN must not be ohend in an matelerr return to.1M office of the Roorrl jl incorn5i. Intpecton.. ba identified their credeMioh. i W~ ~ ~Y ~ ~ • ~ ~ ~ NMI - _...~_-a,~ P4AY M 2199( 214-64 32nd Road Wayside, New York 11361 April 29, 1997 Building Department Town of Southold Main Road Southold, New York 11971 To whom it may concern: Enclosed herewith please find my check payable to Town of Southold for a Certificate of Occupancy for the fence surrounding the pool at my home. The address is 3155 Wells Avenue, Southold. Kindly direct any and all correspondence to me at the above address. Your ~ttent;on to this matter is greatly appreciated. Very truly yours; Carole M. Roke (718) 229-6540 ~ ~ . WELLS AVE. " 72'25' •1. C . b83.R1' N F4A6,STP.D~ rMAi' 23 s,c;r.rv~, Nn. p N ~ p o 8s SGALE % 1~=q~' b ~ ~ ~ per o~ Z _ s7J. " , M ~R. qst r !n~• ^ r- ' J c ~ 1 fw" ~~P~I,b x .k ~ " f. N . Lor 7 Lvr_8 Lor 9 . , ~a. C ~ ~r~ta a, vo.., ~ [~ra f FR. ED OCCUPANCY ©R ,r . •._:a~=-=• _ ~ ~~t~, s,~~r . ~ _ 'Prows~v: q'xw FIxEt~ ~ ;~1~ U$E (5 UNLAWFUL - ~ AaGK ~ 3'X 15'. RAMP, ,t., , r~;: WITHOUT CERTIFICATE N 8i, 4'r2o..c~rEa cocK ~o'x Is' f~a4-r arx`~= OF OCCUPANCY °I' w ~ IN ~O~KEY ~tzEEK, N Ar . soutNo~U, '+rowN Myy .a OF• SoVTHo~p ~ a,:~ ~ _ 8'X15'. RAMP ~ COUNT{ of SL~FFtVK, cy;= . ! "IMMEDIATELY" ../O~,~F 13z.9a, srAt~ of NEW YORK. ~~cpoE wrAr,~: 4RFE Cxls' r~ok _Apput,AtlcN BY: , BEFOgB"NMTEiI"' K.. 6ERT ROKF. ; RATE: AprIL.2.,19~0~-:.:,.~ .,,~t., TILE L ~1D USE G0. IN RIVER N.Y. s~~~r i of r'lELD I;:SP C?i0td ~~UATE ~ i;Oa~iMENTS ~ m J 1. ~ ~ H _ _ _ _ y FOU2IDATION (1stJ f5 FOUNDATIOIJ ( 2nd ) _ - ~ ~i 2. z o W W ROUGH FRAME & ~ i PLUMBING H 3. ~ m I1ISULATION PER N. Y. y STATE ENERGY CODE m a 4 . ~ 02 © ~ J y ~2 _ _ FINAL S" fz ~ ~ ~ DOoe~-- ek.- fo ~ .~.t~ Crvm - - ems. ~ z ADDITIONAL COMMENTS:a2"~`` ~ x ~a~ ~ U; x.•. ro H _ ? ~ H .0 o d z x A - ~ C7 m -o H o~~FFOUr~oo VICTOR LESSARD ~ Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR 1~ P.O. Box 1179 (516) 765-1802 ~ ~ Southold, New York 11971 FAX (516) 765-1823 yQ ~ ~,yod ~ yao OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD May 8, 1990 Bert Roke 3315 Wells Ave. Southold, N.Y. Re: B.P. #171862 Pool and fence Dear Mr. Roke: I am writing to you regarding the above Building Permit. It has expired and you have never scheduled a final inspection and you do not have a Certificate of Occupancy. This is a violation of the Code of the Town of Southold. Please call our office to set up an inspection. The underwriters certificate is in your file for the electrical work. After you pass the inspection please file for a certificate of occupancy. Thank you for your prompt at- tention to this. Yours truly, Secretary ~ ~c~6~ ~~Q 765.1802 BUILDING DEPT. eNSPECTeoe~ [ ]FOUNDATION 1ST [ }ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [)FRAMING [I~FINAL POOL REMARKS: ~ , _ r r DATE ~2~INSPECTOR r ~ ~ E , _ »ti r 765-1802 BUILDING DEPT. f NSPECTION [ ]FOUNDATION i5T [ } ROUGH PLBG. [ ]FOUNDATION 2ND [ ] 1 ULATION [ ]FRAMING FINAL REM KS: ~ ~ ~d DATE ~ ~_INSPECTOR ~ +~ZZ~ c~4~L~ ~~1~~~ T65-1802 BUILDING DEPT. INS~ECTIC~?N [ ] FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ]FRAMING [ FINAL [ ] FIREPLACE S CHIMNEY REMARKS: DATE INSPECTOR ! ~ ` 0 T65-1802 BUILDING DEPT. 1 NS~ECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INS ION [ ]FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ ~.~,G'G/~ ~1~`~ DATE ~ ` INSPECTOR BOAKD OF HEALTH O 3 SETS OF PLANS FORM NO. 1 SURVEY _ a ~3dd r~ TOWN OF SOUTHOLD CHECK • 31~Q~ - w~ Z 7 ~ BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY BLDG.DEP7. SOUTHOLD, N.Y. 11971 CALL TOWN OF S TEL.: 765.1802 " " " " " " " " ~1'IOLD MAIL T0: Examined , 19~~i'. Approved ~ 19~ Permit No. ~ .7 ~ 4 , ~G Disapproved a/c o-~ .................................~~~:.C~~ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT s~ ~~77 Date (9.~.O.C 1........, 19r2~.$ 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ..19. ~ Y~'~lF.4k..t..sxr~s,,.,~vC.,...... . (Signature of applicant, of name, iF a corporation) (Mailing address of applicant) /(9'S L State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,a - , . Name of owner of premises e~.r...... ~ . (as on the tax roll,Rr.latest~deed) If pl nt is a corporation, signature of duly authorized officer. ..i~ 3n~ eSRt a .=s E. . ~ ~ ~ E~ t (Name and title of core a officer) ~ ~ ~ YS~~is,"~'".€~.~_;o~~, ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED *3~'r~ti:a':2es~z.7,~~.>re ~ , Builder's License No. `~-.~jf /~f . Plumber's License No . . Electrician's License No. yt .D.~~.il! ~.L ~ ~ C.. Other Trade's License No . . 1. Location of land on which proposed work will be done. ~ S „ . ,~11.t , , ,~.S.d. ?e;T. !1?~.. . ~ - House Number Street ~ /I'' Hamlet County Tax Map No. 1000 Section .....~o......... Block ...~~7............ Lot . Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises and/'~in~tended use and occupancy of proposed construction: a. Existing use and occupancy ""~~~~T/~L b. Intended use and occu anc ~'r~ Z'^~ ~ 3. Nature of work check which a ~ r plicable): New Building , Ad o .yNt p t ~ n ",1 rk P oval Demolition • • r o . ~ Description) 4. Estmated Cost emO . O . Fee ......s . ' ` (tb be pgFid„p]).~~'• g~h)~s ap lication) 5. If dwelling, number of dwellingll t~ units Number of dwelling ~rni~¢;o~,~96t) kT6~oi~.-: , . If gore e, number of cars " g ~ 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 ...............NunberofStories..............'.........................................: I)imensions'of same structure with alterations or additions: Front Rear . Depth : ..Height Number of Stories . 8. Dimensions of entire new construction: Front Rear ...............Depth . Height ...............NumberofStories........................................................ 9. Size of lot: Front Rear Depth 10. Date of Purchase ..........:..................Name of Former Owner , . 11. 'Lone or use district in which premises are situated . 12. ])oes proposed construction violate ny zoning law, ordinance or regulation: 13. Will lot be regraded . 14. Name of Owner of premises . , u • • • Will excess ill be removed from premises: Yes ~?ZT....IZ~1<,,tr ,Address (~Lt~GCl..... Phone No.. . Name of Architect ~ Address ...................Phone No............... . Name of Contractor ~E7~L.r1.~-...Sl~.f ...Address ..,t1.W.7.T(~G... Phone No..2-.~1.'tp :.(iL,d.B~ 15. :Cs this property located',within 300 feet of a tidal wetland? *Yes No *:Cf yes, Southold Town Trustees Permit ma be reqgu~ired. PLO DIAGIZ.SM Locate clearly and distinctly al# 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. S,u.~~ ~Y APPROVEp AS NOTEp DaTE: ~ 8 B.R a 1~/ 8 ~ FEE: / •~'y • ' BY: Q•'L. NOTIFV BUILDING pEPARTI~,AENT AT 765.1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: t, FOUNDATION TWO R~OUIRED FOR POURED CONCRETE ' 2, ROUGH • FRAMING & Pi;UMBING 3. INSULATION 4. FINAL - CONSTRUCTIQN MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHa 'L MEET THE REOUIREMENT$ OF ~HE N.V. STATE CONSTRUCTION l1 'ENERGY CODES. NOT RE$PONSR3~.E FOR DESIGN OR GONBTRUCTIONIERRORS STATE OF NEW YORK, S.S COUNTY OF • • . • • • • • • • • • • • • . • . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. I Heisthe (Contractor, agent, corporate offjcer, etc.) 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 therewith. Sworn to before me this ~ ~ ' ~ 7.~~p.~.....d~a/y of .j.~ 19 Notary Public, ...l""`."'!'~- ..1.1, •..I. l?..Q-.4/B'~.-...... County i HELEN K. DE VOE i NOTARY PUBLIC. State of New Yak . Term~EKp~r~ Hirsch 30 1~9~ i (S' of applicant) BOARD OF HEALTB FORM N0. I 3 SETS OP PLANS - TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT CUECK TOWN HALL SEPTIC FORM SOUTUOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: CALL Ermined 19.... MAIL TO:.................... Approved 19.... Permit No. Disapproved arc (Iuilding Inspector) APPLICATION FOR BUILDING PIIRMIT f Qom/ • Date.. •~.J~..... , 19.! INSTRUCTIONS " a. This application mist be mnpletely 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 prenises or public streets or areas, and giving a detailed description of layout of piroperty rwst be drawn on the diagram which is part of this application. c. The work covered by this application,m3}r not be mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector krill issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection thra~gl~out the work. e. No building shall be occupied or used in whole or in part for eery purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS I)L~eBY Ml11E to the Building Departiment 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. Tae applicant agrees to ~1y with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ . i r y ~ S ~ rus -:~l~c (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agen~t6, architect, engineer, general contractor, electrician, plumber or builder. Nare of owner of premises ~ . ~D1`,~- (as on the tax roll or latest deed) If applicant is a rnrporation, signature of duly authorired officer. (None and title of corporate officer) Builders License No. ~ Plumbers License No . ~ Electricians License No. ~ Other Trade's License No . i 1. Location of lard on which proposed work will be do er~.~ I SSA ~ t~ 0~`I~ ~z'`~ ~`Q House Number' SCreet ~~jjHanffet Canty Tax Map No. 1000 Section Block Lot ..4 Subdivision Filed Map No. Lot (Nare) 2. State existing use and ocagrar~cy of pr®uises aal intended use and occupaz~cy of proposed construction: a. Existing use and occupancy ...........l~X::~-:~: F~-~~:4~.~-:'S~:........`._.' b. Intended use and ocaipaz~cy ~ . •.Nb~,3N•.11rp~ • • • • • • ~fOY YM1R t4 f'dlABf. ,Ri1du9 fk!i!0(~ Y9+WCN s z!la13alR nr k~itil~vg' tt&Jd'iCA~2tp.trll ,.,.r~.,....t~ !(t!M! z~+tregatN pY9R~' 3. DDruire of work (che(lc whicF( app}icable): New IkiiLling AddiCion AlCeraCion Nepair Rarnval llerrolition Outer 4brk (Description) 4. L"sCia~terl Cost .~~.t,~~ fee ! (to be pair] nt filing Chia applicaCion) 5. TE rA~elling, txnber of rlwelling~uniCS tirrber of rkrelling rmita a~ eacJ~ floor If garage, nnix:r of cars G. If Ixtairesa, rnnrercial or mixes ocnrpancy, specify nature arxl exCent of each Cype of use 7, llintensiats of existing atnxaures, if any: hronC Rear Depth Ilci~tC Nmber of Stories Dinenaions of same atnrcture wl,th alterations or addiCiona: Front Rear Dep(h tleigltt limiter of SCOriea R. Diu~enaia(e of enCire new (nnal'rucCiar: RronC Rear DepUt liei~tt limber of Stories 9. ;iize of lot: 1lrxtf ...........I,..,....,. Rear Depth 10. rktl:e of [1trrJtaae Nano of honrer Dexter II. Pure or use disCricC in which ~ranisea are si[uated 12. Tbea propoae(1 consCnxaion viol,aCe any zoning law, onlinance or regulaCion : 13. Will lot be regraded .........J,.......... Will excess fill be removed fYan praniaea: YRS NJ 14, (vanes of Owner of praaisea ..~,PcdY,p(;;~~Z714,~~.... Acklresa . rS~-~............ Nxx~e No. R7ne of ArcitiCecC .....I Arklresa Iiwrre No. n Nerve of Contractor , J':.~. «:'4 ~f~S....... A<klreas ~ ~O$ 5- .....................Plxtre No. 15. [a ibis property within 300 f ~f of a tidal ~xtlnxl? * YhS NO *IT YIS, SOUnI(An 10lvll 7~S'[RRS I'gl3lrr MAY [iR R[.QUTRf~, ! PL0'f 11IAGRAM YncaCe dearly arxl disCinctly All buildings, wltedter existing or proposed, and indicate all set-back dimensions fmn property lines. Give aCreeC arxh block nni~er or description according to rk~ed, and show street mares arc] irclicate whether interior or correr lof. II srrcn: (x~ ww ycxut ~t~ _ `-Ca V© ~-e .Q,...............being duly swrn, deix~aes and nays LhaL 6e is Use applicant (Nape of irxlividual signing contrac alxrve n~ned, ! (Crnttraclar, agent ,'corporaCe officer, etc.) oP said rxamr or owrx:ra, nrxl is duly] aulhorize(1 Co perform or have Ierfornae(1 We caul work atxl Co nuke and file Chia appliCaCi(nG Chal: all. aCaCenenCa crnr1~aitx~d in Lhia aplil.icaCi(m are Cn~e Co Che beat of his krcawle(4;e a~xl belief; a~xl LhaC the work will lm perfonnerl in l+te tn~rnter aeC forCh in Ure applicaCirm filed Clrerewitlr. 9wurn to Ix:fore me this .G+~.~.1~..day of ~ .~7... ~ ~~~r~~ Notary I4(blic ~ a~1 qw~ ~J (SigrkxCure of ApplicanC) ~fQ ~J~IRN '~r ~ a-„ ~ D r Z - R1 'rl ~ WOE ~ r ~ ..1 O ~ mlzn OC""~ Zp _ ~ 3 m ~1 m 3 nl m° O fA ~ p D< O Zi ~ mn ' °z--~Naoor ,°~xon°. ~r o7C ~m~D rC mm3z W p(n ~ ~Z z=' m 'omc~ vo--In~i ~m ~ u AZO=-n~~~ -C tno ti-CI°rmrm-'~r -on z _ .~=Ozr O ~ Or o~ (e ZO ~ a o ~ -C co x WE~~S qVE. E 100 ~ d~ N.81° 40 00 ncc o. c. ~$?r A6. I nN V. Q 683.21' 0.~ a'~ \~N O N p D ~ I ' o' n $ ~ 16•Z r A y, I~ a• ~ - D ~ ~ o, a Z = ; 16.e' ~ . ~ 3• rn ~ m y.1' 1'~ _ w ~ a N -G 3'~ W / ` / `n 45.6 m .L o . rn -1 ,o ~ ,t ~ ~ 2~ ~noelm Z o~. .a pNGy a a~ ~ ~~s ~ SP~N~pW~, p,~E ~R o~ U~ C~R~1~ C~ rt o~ N aa~ Pa 0 ~ F CCp ~ Qµ e. ~ .m / N NO ,r ~ ~ o ~ ? ~ N N , i ip CA ~ .0 D n ~ ~ N 1I VJ T . pl - ~ & a h°' t0, oo O z ~~!-3'~ 1 ~C o ~N ~ ~ ~ W a ~ a ~ N. 8260 W ~ ~ ti m ~ W 132.48 ~ ~ JOCKEY 4 ~ y a~~ "IMMEDIATELY" C R E E K o ~ ~ ~troo~tnooet ~ " ¢ ~ = 11/ON r10M °f ° T R ~ tEFgM"rM~1" a •s f k a ..v