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HomeMy WebLinkAbout24214-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25328 Date NOVEMBER 20, 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 1350 MILL ROAD MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 106 Block 10 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 3, 1997 pursuant to which Building Permit No. 24214-Z dated JUNE 24, 1997 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 NON-HABITABLE ACCESSORY BUILDING IN REAR YARD AS APPLIED FOR & AS PER ZBA #4517 The certificate is issued to GABRIEL L. DARIN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-057921- NOV. 20, 1997 PLUMBERS CERTIFICATION DATED N/A Building Inspe or Rev. 1/81 FORM NO. f 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° 24214 Z Date ..............6/4.. f......................., 19..117 Permission is hereby granted to: ... .:......�.� ..................... . ....... , ................................ X to .... li:7ecC.�f............. ✓....../ .�f`f rrJr .......1 1.5.x? .: .....1✓....: �......& y ...... � ,� s 4............. J.. r....../J. .. ...—.....i,�... —......... ..... . ............ .. ............ at premises located at... .'.Y......... 1.. ......Id...................;1 ..... .`...................... County Tax Map No. 1000 Section ..../Z(a....... Block ......140....... Loot No. .....C23.......... pursuant to application doted ........... (1....-Jj................................1 19..`.../, and approved by the Building Inspector. Fee ... ................ ........B... i ... ..... ........ . g o.......................... f Rev. 6/30/80 Form No. 6 — _ TOWN OF SOUTHOLD 1997 BUILDING DEPARTMENT - TOWN HALL 765-1802 IrNf WOFSO; r ^. n 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 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 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. 1_ 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 Building - $100.00 3. Copy of Certificate of Occupancy - .251Z 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - ResidentialG$/15.000, Commercial $15.00 Date . . . .4.F �' . . l.?. . . . . . . . . . . . . . . . . . . . . . . . . . . ]ew Construction. . . . . . . . .�O7ld Or Pre-existing Building. . . . . . . . . . . . .; ,ocation of Property. . . . . . . . . rn �. .<P. ... . . . . . . . ! !T. 1•, . . . . . . . . . . House No. Street Hamlet :nwer or Owners of Property. .�!R3. � /E L• • �•_ • R 21;J . . . , • • • • . . • • • • • , • . • • • • _ , • . • _ • . • • _ • �ounty Tax Map No 1000, Section. . . . . . . . .Block. . . . . h p. . . . . . . .Lot. . . . . .. . . . . . . . . . . . . . . ubdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map. . . . . . . . . . . . ot. . . . . . . . . ' . . . .Date Of Peit. . .4f ./ / 7. .Ap � • .ermit No. � ] iealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Tanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . �.equest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . ee Submitted: $. . . .o2S0.0 . . . . . . . . . . . . . . . . APPIA CANT APPEALS BOARD MEMBERS Q�Q Cp Southold Town Hall Gerard P. Goehringer,Chairman = 0i 53095 Main Road Serge Doyen o P.O. Box 1179 Southold, New York 11971 x ��, • Fax(516)765-1823 aortora O �Oj � �a� Telephone(5 t6) 765-1809 OCT 1 5 gW BOARD OF APPEALS TOWN OF SOUTHOLD TOWN FINDINGS, DELIBERATIONS AND DETERMINATION ADOPTED AT REGULAR MEETING OF OCTOBER 9, 1997 Appl. No. 4517 - GABRIEL DARIN PARCEL 1000-106-10-3 STREET & LOCALITY: 1350 Mill Road, Mattituck DATE OF PUBLIC HEARING: October 9, 1997 FINDINGS OF FACT PROPERTY FACTS/DESCRIPTION: This property is located in an R-80 Residential Zone District, being situate on the easterly side of Mill Road (a/k/a Cox Neck Road), Mattituck. This lot contains a total area of 1.9323 acres and frontage along Mill Road of 155.72 feet. The subject parcel is improved with a single-family dwelling. BASIS OF APPEAL: Building Inspector's Action of Disapproval dated September 11, 1997 which reads as follows: under Article III, Section 100-33 of the R-80 Zone, the accessory storage building built under permit #24214Z with a finished height of 18 ft. 8 inches has exceeded the maximum allowable height of 18 ft. (Note: Building height is measured vertically from existing grade to a mean distance between the ridge and the eaves.) AREA VARIANCE RELIEF REQUESTED BY APPLICANT• To locate an accessory building for storage purposes incidential to the applicant's residence on this parcel, at a height eight inches (S") higher than allowed by code, for a height of 18'8" when measured vertically from existing grade to a mean distance between the ridge and the eaves. REASONS FOR BOARD ACTION DESCRIBED BELOW: Page (1) The granting of the area variance will not produce an App] undesirable change in character of neighborhood or a detriment to Soutf nearby properties because the neighborhood at a similar height, shows other structures le The benefit sought by the applicant cannot be achieved by some method, feasible for applicant to (3) because the building Pursue, other than an area variance varia continued under Building has n built g and construction activities #242142 dated June 24, 1997 APPEALS BOARD MEMBERS gOFFO(,� 0�0 CO Southold Town Hall Gerard E Goehringer, Chairman h� Gym 53095 Main Road Serge Doyen w P.O. Box 1179 x Southold, New York 11971 R W R 0 W �y • �� Fax (516) 765-1823 a ortora D '�Ol ��O Telephone(516) 765-1809 OCT 1507 BOARD OF APPEALS MDO TOWN OF SOUTHOLD TOWN FINDINGS, DELIBERATIONS AND DETERMINATION ADOPTED AT REGULAR MEETING OF OCTOBER 9, 1997 Appl. No. 4517 - GABRIEL DARIN PARCEL 1000-106-10-3 STREET & LOCALITY: 1350 Mill Road, Mattituck DATE OF PUBLIC HEARING: October 9, 1997 FINDINGS OF FACT PROPERTY FACTS/DESCRIPTION: This property is located in an R-80 Residential Zone District, being situate on the easterly side of Mill Road (a/k/a Cox Neck Road) , Mattituck. This lot contains a total area of 1.9323 acres and frontage along Mill Road of 155.72 feet. The subject parcel is improved with a single-family dwelling. BASIS OF APPEAL: Building Inspector's Action of Disapproval dated September 11, 1997 which reads as follows: under Article III, Section 100-33 of the R-80 Zone, the accessory storage building built under permit #24214Z with a finished height of 18 ft. 8 inches has exceeded the maximum allowable height of 18 ft. (Note: Building height is measured vertically from existing grade to a mean distance between the ridge and the eaves. ) AREA VARIANCE RELIEF REQUESTED BY APPLICANT: To locate an accessory building for storage purposes incidential to the applicant's residence on this parcel, at a height eight inches (8") higher than allowed by code, for a height of 1818" when measured vertically from existing grade to a mean distance between the ridge and the eaves. REASONS FOR BOARD ACTION, DESCRIBED BELOW: (1) The granting of the area variance will not produce an undesirable change in character of neighborhood or a detriment to nearby properties because the neighborhood shows other structures at a similar height. (2) The benefit sought by the applicant cannot be achieved by some method, feasible for applicant to pursue, other than an area variance because the building has been built, and construction activities continued under Building Permit #24214Z dated June 24, 1997. Page 2 - October 9, 1997 Appl. # 4517: 1000-106-10-3 (Darin) Southold Town Board of Appeals (3) The requested area variance is not substantial representing a variation of less than one foot from the code requirement. (4) The proposed variance will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because the extra eight inches is visibly unnoticable and without affect to any nearby views. (5) The situation has been self-created. (6) This action is the minimum that the Board deems necessary and adequate 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 Dinizio, seconded by Member Tortora, it was RESOLVED, to GRANT the relief as applied and SUBJECT TO THE FOLLOWING CONDITIONS: 1 . No sleeping or habitable quarters in accessory building, as required by the zoning code. 2. No kitchen or cooking facilities in accessory building, as required by the zoning code. VOTE OF THE BOARD: AYES: MEMBERS GOEHRINGER, DINIZIO and TORTORA. This resolution was duly adopted. (Member Doyen of Fishers Island was absent. ) GERARD P. GO HRINGER, HAIRMAN RESOLUTION ADOPTED Actions.all/106-10-3 r�1p M11 nlrl, I I'( IVN OF ,SOI I'I M)1-1) IIOILI)ING D1-,I'A CVA l liNV IO WN CI,ER rc'S OFF ICF SOI!'fl101_11. N.Y. NO I'ICG OF DI.SAr rROVn1/�/,,(�. q � r/ PLF I\Sr AKf4 NO1ICF(I I y mr ip plicalimi I:i Ierl . . . . . . . . Z7 . . . . . . . . . . .. 1097. . for permil In '/7�'i�*""'.'�.'�yQy$moi . . . . . . . al I I_ociliou n( Prnperly . .l.dd. . . .!�!. . . !!}-� . . . .�!.rte . . . . . . . . . . . Hnnre Nn. / Srrwwr /Inn,lwr j County Tax Map No. 1000 Section . . . Block . . . . . . . . . Lot -. Subdivision . . . . . . . . . . . . . . . . . r'iled iAhip No. . . . . . . . . . .j9 . ®LLol No. . . . . . . . . . . . . . . . . ix 1mor--d� herr.with aunt ilisalgn nvr•rl un Ihr follrrwinp. prV nn dS"Y'.'.'t/"�'i-. 7.3.3� .�f. t�. /cam .1-1�. �f... . . . . �23'-!c•GGt-�(Gnsecc . . . . /J _ �_07`���f�.�u*�c. � . . - - . . . . . . . . 0u i. I rj �I"Spp_I:OC . . . aV 1 /nn THE NEW YORK BOARD OF FIRE UNDERWRITERS FAGS 1 806$532 BUREAU OF ELECTRICITY 85 JOHN:STREET, NEW YORK, NY 10038 Date NOVEMBER 26,1997 Application No.on file 14933097/97 H 057921 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the abom application number in the promises of GABRIEL DARIN 1350 WEST HILL ROAD, MATTITUCK, NY inthefollowinRlocatioOER 21,1997 n• C1 �ry Basement LI 1st Fl. M 2nd Ff. OUT Section Block Lot N upas examined on and found to be in compliance with the National Electrical Code. FXTUWARECEPTCLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WA MENS EXHAUST FAN OUTLETS INCANDESCENT[FLUORESCENT OTHER AMT. K.W. AMT. 11 K.W. AMT. K.W. AMT. K.W. AMT. H.V- 8 19 9 ?1 DRYERS WRNACE MOTORS FUTURE APPLIANCE PEEDERS SPECIAL RK'PT TIME CLOCKS EELL UNIT NEATERS MITI-OUTLET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.►. NSYSTEMSO.OF FEET AMT. WATTS SERVICE DISCONNECT NO-OF $ E R V 1 C E AOM AMT. AMP. TYPE gWp. 1,92W 1 0 SW S M 3W S X 4W NO.FR C.COND. A.W.G.COND.C. NO.OF HIAEG A.W. G. NO. NEUTRALS A-NEARAI 1 100 CB 2 X L ' ;3/0 1 3f0 OTNER APPARATUS: — a ROBERT DARIN ( L L P. 0. BOR 653 MATTITUCK, NY, 11952 GENERALMANAGER 11 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by tWr credentials. CQPY 'FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. tae � For. FIAv%.E � « �Tt�tN I i APPROVED AS NOTED NOTIFY BUILDING DEPAiATImtNT A �^. 785-1802 8 AM TO 4 PM FOR THE 0� V 1. FOWING U DATION-TWO REQUIRED C " FOR POURED CONCRETE 2. ROUGH - FRAMING • PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET 1 CODES. NOT RESPONSIBLE FOR I DESIGN OR CONSTRUCTION ERRORS ILA , R1k OCCUPANCY OR USE IS UNLAWFUL i3so w^u RO WITHOUT CERTIFICATE MPrnI7-v0< REQUIRED OF OCCUPANCY Fo��oo��ovJ P x � Spy J � r it �'ry i 1 1 C�C C V s. lA 9 � N I � � m M M I f r I 7 N R G.AflQ1� __ ►3So w,m�u_ RD M AIT tTUC L laN&CPa oar S�ptt 6 pG z+bd' 3�Q��Mi�l i35o u3 ,roti�� YID �r17i•rt.-IL 6 �✓EiZV-oTrlDf) i/ �� _ Ips uloc C 7 10 1), -%axaa CG Z,- 7= Po Y4 I, WOO 1, ►t,'o'' � �'o" — �.03�o �3►ti I I Q, PA I kup +G , 'bA2►�J I*�So WI M14L MALT t x ocy, 2NOFt, t'LAQ REV 151otJ 2"1°fL. YVC- - � 1 Ile"{34 Tiet 1 ItoG 2x$ (�p110G _ 5 'Slot C� 21 19 16110c- 3- Gi ancA Ge 3 �a+-L+ �t o1 _ G , DA944141 _ 13SD W1t1'Iu- M All ITU U< - TI-n i? SrouJ6 - 5„�' � 3 - Z+�yG�aoea- cc.q i G, t'7A2it� M.1 U- po _ _- N � 5 E►-EV�D� - �Et/ ►Sio� - -o ate° �. 7.43 0 t r s i A AN9 13Sa U1, m�t,�R1� M R t[ T\jCK _ ZN0 FL., ?�LFiN REvisrc N/O/F WOL BfRr l + SII•JI'JO'F / N/ O/ F ✓ Q O 700. �` SEP'y CA RL rON 4 3.03'10-E l( 7D, 1 A W W4.ta' n } FV/ ST�i1C''1 i �J 4 EA - f 9,3P3 ACRFS '(4 v C s \ pl N/ Iv,y O/F "HEDA 5J69C' � SNUG HA SURVEY FOR (^AbeL __ UnauthwaW NrerataeG6tianbthe turs'N�sIMe4- �� DARI ' se;h 7,-, rtMN b W Sd.it eSIV VW'l at;n�r-,.+Vev mp rsm evtq rti lnEs.rvgcr' AT MATTITUCK T'°d��o. ..;csswwisnan�esMwrr�ea.ed w be e TOWN OF SOU7HOL0 f'l'ap � /1/GFfj , calm uPv % ' l .F Ua RR N7EE0 1G+ OF WAts 'nd,,W Aaeonirnm N SUfFOLK GOONTY, .Y. A5 AMERICAN 71Yt£ tmS_RGRCF COMPANY 00'y renAiceGans en wbrf Uie aYrvalYpreps• 'faMc^hia * * NYORK iSCALE• y�=�1}[ �,I BERT G KAREN OaRIN i srsa eerarn,eM m[M sfcipnees al the - _ 7� fes+' �\ 1 J JC '�� GvaemaK a urlKtstinns en nm n�,iaable:c aamtwroiirmsiyriyaor eu0squantow+e.s \.�,LS�.D/d 11116�� �y.�.. .i.�4�.. LANO S SUR v EYOR N Y 5.LIC NO Z67Z5 RNERHERO, N.Y J BUILDING DEPT. INSPECTION [ ZFCUNDATION IST [ ] ROUGH PLBG. [FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ j FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE � INSPECTOR BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. ( ] FOUNDATION 2ND [ ] IN S TION 1 FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: �/I�+e/�r.�� s Xf , DATE INSPECTO M-1102 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN CATION I 1 FRAMING [ FINAL [ ] FIREPLACE & CRIMNEY REMARKS: ,,0' / io� 71 DATE��1'�/ -INSPECT I I n l t!I I r•u n r l r, x - --------- __.+ — ----- ___._--�_.._..— __.x f:f 1111! i' I PIA I. .-_.._._---_- ---_-- - --------------- LET ------------ 1 ~ HOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPAR'174ENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . „ •' 3 I�:)(�� %I', TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD N.Y. 11971 ` . ...i TEL: 765-1802 NOTIFY: ' o e) DAQ.11l,) f.Lr) c Es'r. ._ .s cALI. . .a:q_ .' S'1(o 2 *rr'k^qpm Or'i0 ,.,. . . 19 57 MAiI. Approved......... '�„I:. 19 Permit 'No. ................ .....VA Disapproveda/c .................................. ..........................t n�.�. ..................................................... b` -•(Buildin n to APPLICATION FOR BUILDING PERMIT Date. .. YU 4L. . 3 . . . . 07 INSTRUCTIONS a. 'finis 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 sciieckule. b. Plot plan showing location of lot and ofbuildings on premises, relationship to adjoining promises 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 application. c. The work covered by this application may not he 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 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. APPI.I(.AITON IS IEREBY MNlC 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 Regmulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to caTly with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildi or necessary�inspections. (Signature of applicant, or name, if a corporation) .1040)9✓.o-'.4s..�../4.1A 71DTVQ . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (`....� N:T................................................... ........................ Nana of owner of premises .....�ft e l E.L .. .. V '.I....................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. ....... !V C:(Z...... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... I. T ocation of land on which proposed work will be done.... 1 5-0...VF5 �.... ).fir:Vis.�:��'�. �................ Fk`1T ►c ....Raue.........Mtv� .S�Street !....................................'-}lanlet.._........................ Number Canty Tax Map No. 1000 Section ....f�r..�P..... Ill ock .......f Q..... Int ......... ...... Subdivision ...................................... Filed Map No. ............... Int ............... (Name) 2. State existing use and occupancy of premises,.and intended use and occupancy of. proposed construction: a. Existing use and occupancy .............(Y©N_�R................. .................................... b. Intended use and occupancy .......... �:r4� ,_ U L J 11�, ............................... ). P:•Uure of work ((-he(,k wlridi a14)licable): Noir Ikiil(linl; ... .... Mklition ... Alteration ...... 14!I)air ............ RenovaI ............. Denxrlition ............ Other 14ork Ae-�k- :� pky............. (Description) 4. I:sL inx►l:ed Cost: ....9.1.v.00 1111...... fee .............................................. ((o be pair) on filing this application) 5. If (kacel l ing, nuid er of ck.+ell i►tg uniLs ............ i vd)er of ckael l iog units on each floor ................ If garage, otsiber of cars ...................................... 6. If lxcsiness, mmrercial or mixe(l occupancy, specify tuiture a►xl extent of //each type of use...................... 7. Dimensions of existing structures, if any: FronL.....�q..... Rear ..T..q ....... Depth .,02. ......... lieigl►t .......... ........... Kxiirer of Stories ........I............. Dinlensicxrs of sane stnrghtre with alterations or arklitions: front ............... Rear ............... Ikepth ............ Height .................... Mlrrirer of Stories ............... 8. Diuxensions of entire new construction: Front: ................ Mar ............... Depth .............. A Ileil;l►t .......................... Nxrirer of Stories ..................... 9. Size of lot: Ihx►t ..... J. I........ hear ...... .... .. Depth ...... 10. Mile of Purchase .MAY...t"lq.1... Nmw-, of Former Oinrer ...�R f'��-r.1 .. � i. ........ 11. Zone or use district in wllidr premises are situated .....I 1................................................... ... 12. flies proposed constmetion violate any zrxiing tau, ordinance or regulation: ......14�............. 13. WiII lot be regraded ......M-0....... Will excess fill be renraved firan premises: YES �•y��` C+�/ M. t4-mnes of (later of prenises G.Ar$em;...�.:.:DATR1AA. Mklress .����.w ]�� .. 1'1►orre No. Mameof Arcllitec:t .................................... Mklress .............................. 11 me Nc). .............. Mime of Contrac:tor ................................... Mklress ...............................Nixie Nn. .............. 15. is this property within 3(X) feet of a tidal wetlaml? * YI?S .......... N) ..k..... *1F YI:,S, S(XIIiYAD 'JU M 7RUS117?S IEIMI[T MAY ISPs Fur plltl-D. PIAT DiAGRAM locate clearly atx] distinctly all buildings, vAwLiler existing or prolxrsed, arxl it'xlicate all set-back dimensions from property lines. Give street and block riuriber or description according to deed, and show street rums arxl i►xlicate til►ether interior or corner lot. (A' PAW Yo lm, ....... ......................being duly sworn, (Ielx)ses aril says dint he is tl*, nppl ic:ml (M:nxe of irxlivicl(url signing contract) :►Ixtve runxed, ; r Ike in 1_Ire ......f=l�-f! .......................................................... ............... (('.mLrartor, agent, corlxrrnte officer, etc.) of said (xnxer or (rw1►ers, aml is duly mithorized to lxerforrn or have (xerfonrr_(1 the said work arxl to make mxl file this :11)1)1 ic: Lion; that n)I slatenents c(n)tairxe(1 io II►is nlq)l ication sire Litre to the* (rest of his k►xrwle(Ige mxl Ix4 ief; nlxl Ihat the mirk will Ire perfornled in the ►►annrcer set forth io the application filed Lherewi01. `lx►rn to Ixefure nn Ihig JUA �'7 ............dpy of .. - ....... 19 ...(. Notary I'ltblic ................... ............... I ICX� MELANIEV.BROWN (Sigmt.ure of ApplicnnC) . Naury Pthk Sbb of liver Yak No.4911 2 Oud wd In M*Courdy Commwion Expires Od.i9,i9q_7