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Home My WebLink About16884-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildmng Inspector Town Hall 8outhold, N.Y. CERTIFICATE OF OCCUPANCY No Z19167 Date JUNE 26, 1990 THIS CERTIFIES that the building. ALTERATION Location of Property 15775 NEW SUFFOLK AVE. NEW SUFFOLK House No. Street Hamlet County Tax Map No. 1000 Sectlon 117 Block 06 Lot 22 Subdlvmslon Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 5~ 1988 pursuant to which Building Permit No. 16884Z dated APRIL 8~ 1988 was issued, and conforms to all of the requmrements of the applicable provisions of the law. The occupancy for which this certificate is issued ms ENCLOSE EXISTING DECK AND REPLACE PERMITS 8135Z & 10962Z. The certificate lS issued to EDWARD ~UINTIERIr JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N131101 MAY 25~ 1990 Bumldlng Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19168 Date 073NE 26, 1990 THIS CERTIFIES that the building_ ALTERATION Location of Property 15775 NEW SUFFOLK AVE. NEW SOf'~'OLK House No. Street Hamlet County T~x Map No. 1000 Section 117 Block 06 Lot 22 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 5r 1988 pursuant to which Building Permit No. 16884Z dated APRIL 8~ 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 ADD AN ENTRANCE ONTO THE F~ISTING DWELLING ON THE EXISTING PORCH FOUNDATION. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A THIS PERMIT REPLACE B.P. ~10962Z Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Offzce of the Buzlding Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19169 Date JUNE 26, 1990 THIS CERTIFIES that the building ADDITION Location of Propert~ 15775 NEW SUFFOLK AVE. House No. Street County Tax Map No. 1000 Section 117 Block 06 Subdivision Filed Map No. NEW SUFFOLK Hamlet Lot 22 Lot No, conforms substantially to the Application for Building Permit heretofore filed in this offlca dated APRIL 5~ 19S8 pursuant to which Building Permit No. 16884Z dated APRIL S~ 1990 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which thzs certificate ls · ssued is ADDITION TO EXISTING DWELLING. The certificate zs issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED EDWARD ~.UINTIERI, JR. THIS PERMIT REPLACES B.P. ~8135 Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTM£NT TOWN HALl. SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N 16884 Z County Tax Mop No 1000 Sect,on . .Z'../. ~. ...... Block ...... ~...~.. ...... Lot No . .~.. ,'~.... pursuant to apphcahon doted ............. ~,....."T... ~ ............. , 19..~., and approved by the Budding Inspector. Rev 6/30/80 :OWN OP $OUTHOLD JILDING DEPARTMENT TOWN HALL 765-t802 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 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 furm). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used mn system contains less than 2/10 of 1% lead. r $. Commercial building, industrial building, multiple resmdences 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-existmng" 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, Addztmons to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $i00.00 3. Copy of Certzficate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Conmaercial $15.00 ............ Date ...... ~....~. ..... New Construction .......... ~.Old Or Pre-existinm~Bullding....~. ...... ~''''- 'D iii ''iiii Location of Property..~..~.~.~ ....... 0.~ .L~....~L~L~.~.)~ ~[..~'41~.~. ........... .~.~ .~.~.~J~-~. House No. Street Hamlet Onwer or Owners of Property ....... , .............................. County Tax Map No 1000, Section. ,.½ ........ Block .... .......... Lot ...................... Sebdivision .................................... Filed Map ............ Lot .................... .. Permit No.../}&.~X.~.~.. Dar Of Permit ................ Applicant ............................. 0~' &~z~ ' e ~ealth Dept Approval Underwriters Approval . Planning Board Approval ..................... Request for: .Temp°rary Certificate ......... Fee Submitted: $ .................. ......... .. Final Certicate..../. ...... THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000665 BUREAU OF= ELECTRICITY E5 JOHN ~,TREET. NEW YORK, NEW YORK 10038 ~t~ AppllcaHon No. on fil~ THIS CE~IFIES THAT ~ exami~ on andf~nd to be in complionce with the r~ui~ment~ of th~ ~ard. RXTUEE OUTLETS SWITCHES RXTURES RANGES OVENS DISH WASHERS EXHAUST FANS SERVICE DIS¢ONNECT S E R V I C E OTHER Mq~ARATUS: PANEl 80AF~DS: J 12 A, W, O, NO.O~ H~LEG A.W.G. NO. OF NEUTRAL5 . ~CC#¢O~D. O~ CC. CO~V. ) / 0 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Insl~ctors may b~ identified by their credentials, COPY FOR BUILDIHG DEPARTMEHT. THIS COPY OF CERTIFICATE IdLIST HOT BE ALTERED IH AHY MAHHER. DUNDATION (1st) DUNDATION (2nd) ]UGH FRAME & FLUMBING 'SDLATION PER N. Y. STATE ENERGY CODE FINAL ADD!TIO~AL COMME~TS: FORM NO. -~ TOWN OF $OUTHOLD BUILDING DEPART/v~,ENT TOWN CLERK'S OFFIC~E SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Dote March 22 ........................ 1988 TO Mr. Edward ~uintz.e. rz, Jr. (owner or authorized agent of owner) 290 Summzt Ave. .... ~..t.......V..e.r.n o..n.~....~.,.X ,....LO..%%Z ................... (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a walahan of Zoning Ordinance Other Apphcable Laws, Ordinances'or Regulations at premmes hereinafter desc,bed ~n that.....Alceratz°ns..... ... Chap. 100 & new building is bezng (state character of wclatlon) done without building permzts. in wolotlon of Art,. XIV, Chap. 100-14 ! (State sechon or paragraph of apphcagte law, ordinance or regulahon) YOU ARE THEREFORE DIRECTED AND ORDERED to comply w~th the Iow and to remedy the canal,hans above mentioned forthwith on or before the Immedzately day of March 19..8...8. r. The prermses to which this ORDER TO REMEDY VIOLATION refers are s,tuated at 1 5.7 7.. 5 ..~ .e..~.....S...u.~.f..o.~.k....A.y..e..: .~.. ~.¢.¥. ............ County of Suffolk, New York Suffolk Suffolk Co. Tax # 1000-1J7-6-22 Podure to remedy the conditions oforesmd and to comply w~th the apphcable provJmons of law may const,tute an offense pumshoble by f,ne or ~mpnsonment or both Budding I~pector Vzncent Wzeczorek APPROYED AS NOTED NOTIFY BUILDING DEPARTMENT AT 765-180~ 9 AM TO 4 PM FOR THE FOLLObVING INSPECTIONS FOUNDATFON - ~NO REQUIRED FOR POUPFD CONCRETE 2 ROUGH - FRAMING & PLUMBIN~ 3 INCIJLATION 4 FINAL - C~NSTRUCT[ON MUST B~ COMPLETE FOR C O ALL CONSTRUCTIOF~ SHALL ME~ THE RE~]lpEMENTS O~ THE N Y ~TATE CONSTRUCT/ON & ENERGY ', CODES NOT R2SPONStBLE FOR SIGN OR CONSTRUCTION ERRORS. r AP;'J.R~. _D AS NOTED 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2 ROUGH - FRAMING & PLUMBING 3. INSULATION 4 FINAL CONSTRUCTION MUST BE COMpI FTE FOR C O ALL CONSTRUCTION SHALL /'*rE-r RE UIR~MENTS OF TH: THE 0 -- STATE CONSTRUCTION & CODES N'")T RESPONSIE~! c DESIGN OR CONSTRUCTION OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUI~ING DEPARTMENT TOWN CLERK'S OFFICE ~UTHOLD, N. Y. ...... .............. .( ............ {Bui~din~ APPLI~TION FOR BUILDING PE~IT INTRUSIONS a. This application must be completely filled in by typewriter oe 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 ofproperty must be drawn on the 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 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 buildings for necessary inspections. / .................................... / (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... : .............. ~..'.'.'.'.'.'.'.'.'~..:~. ~. ~ ................................................................................................................................................... Name of owner of premises ......... ~..~...~. ......... .~.!.~,. .)..~...~.....~. ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... ~~ ........... Plumber's License No ................................................. ~,~'~ Electrician's License No ............................................. -~ Other Trade's License No ..... : ......................................... ~ /,~ ~. Location of land on which proposed work will be done. Map No.: ............................. !;..2...~;J~t ~l/q~ ........................ Street and Number .... ~.~.....';~....N.~).......~.'...~....~.O.l.~.....~.~....'Tm.. ............. ~....~~..~... ...... :,,.: ............. -- ~/~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................... ~..~.~........~v,...i~iiiiiiiiiiiiillI...~.....~..~. b. Intended use and occupancy ................................................. 3 Estimated Cost ...................................... If dwelling, number of dweJhng units ........... Nature of work (check whmh apphcable) New Budding ............ Addition ..V/.... Alteration Repmr ......... Removal ......... Demohhor .. Other Work (DescrJphon) · . .Cee iib"~;;"~o;Z'~"~,ng this · ·.Number of dwelling units on each floor .............. If garage, number of cars 6 If business, commercial or m~xed occupancy, specify nature and extent of each ~pe of use 7 ' D~mens~ons of existing structures, if any Front. ~-~'. ........... Rear , .~..~-~, ~..' ............. Depth .. Height ..7 ................. Number of Stories ...... ~',.D ~'.. ~ ........................................................... .... ~ .................... Rear Dimensions of same structure w~th aJterohons or addmons Front m ' ' ..... Depth .~.~%.-.~, ................... Height ).,~ .................... Number of Storms ..,.J ............ 8 g~mens~ons of entire new construchon Front , ~ I / Rear ) .~ ~.' . Depth / ~ ' ' Height ~ ~ Number of Stones 9 Size of lot Front ............................... Rear .... ~.~.~' ............... Depth ....... ]0 D~te of Purchase ...................................... N~me of Former Owner 11. Zone or use d~stnct m which premmes are s~tuated ............................................................. 12 Does proposed construction wo{ate any zoning I~w, ord~nonce or regulation .... [%.U ............................. 13 Wdl lot be regraded ........... ~ ............ Will excess fill be removed from premases. ( ) Yes ( ) No Nome of Architect ................... Addr~s ............................. Phone No ................... Nome of Contractor ......................... Address ............................... Ph~e No ..................... PLOT DIAGRAM Locote cleoHy and distinctly oil buddings, whether exlsbng or proposed, and ~ndlc~te all set~ck d~menslons propa~y hnes Gwe street and bloc[< number or descnptaon according to deed, ond shaw street n~mes and md~cat whether mter~or or corner lot STATE OF NEW YOR~. ,, COUNTY OF . . .~ L± ~.~.~.C ...... fS S ....... ........ ,e,ng depose ,:,nd soys that he ,s the opp,,con, (Nome or ina~waual signing contract) above named He ,s the ......................... ;;. -./~. ~4/./g/~.~' ............................................................. [L. on't'ro;'t'o-°eor, ag at, corporate off~cer, arc ) of sold owner or owners, and is duly au(hat,zed to perform or have peri:armed the said work and to make and fd~ this apphcahon, that all statements contained' m th~s apphcehon are true to the best of his knowledge and behef, ant that the work will be performed m the manner set forth m the apphcot~on filed therewith Swam to before me th,s ...... ~(.~ .... do~ of ....,~/~r~,, ....... , ~9 ';~ Notary Public, . ..................... .~..'~'~..~L(.~ County · ..)~-, '.,.. ~/~" /, '-' ........... .......... BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO 1 SURVEY TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y, 11971 TEL.: 765-1802 CALL ................ Examined ,~/'/? ..... I9 Set/ Disapproved a/c MAIL TO: APPLICATION FOR BUILDING PERMIT Date .. , 19., INSTRUCTIONS a. Tins apphcahon must be completely filled in by typewriter or in mk and submitted to the Building Inspector, w~th sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showing locatxon of lot and of bmldmgs on premises, relabonsh~p to adjommg premises or pubhc stm¢ or areas, and gwmg a detmled description of layout of property must be drawn on the diagram which m part of th~s apg cation c. ~e work covered by t~s apphcatmn may not be commenced before ~ssu~ce of Budding Permit d. Upon approval of thru apphcaUoa, the Bmldmg Inspector w~tl msued a Building Pe~t to the applicant Such peru shall be kept on the premmes avaaable for mspectmn throu~out the work. e. Ho buadmg shall be occupied or used m whole or m p~t for any purpose whatever untd a Cemiacate of Occup~ shall have been granted by the Bmld~ng Inspector~ ~PLICATION IS HEREBY MADE to the Budding Dep~tmant for the issuance of a Bmldmg Pe~it pumuant to t Budding Zone Ordinance of ~e Town of Southold, Suffo~ County, New York, ~d o~er applicable ~ws, Oram~ces Regulatmns, for ~he constmcnon of bu~d~gs, add~Uons or alterations, or for removal or demoh~on, as hereto desc~b~ The apphcant agrees ~o comply w~th all apphcable laws, ordinances, buH~g code/~ons~g co~, and ~gulatmns, ~d admit authored mspectoa an premmes ~d m budding for necessa~ ~n~ons //, ~ ~ ~ k .... ~i~at~;o o~ ap~icant, or name, ifa corporatlo.) (Malhng address of apphcant) I ~ 5',~). State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmlr (as on the tax roll or latest deed) If apphcant ~s a co~orabon, sxgnature of duly authomzed officer ........................................ OCCUPANCY OR USE IS UN WFUL ALL CONTRACTOR'S MUSTBESUFFOLK COUNTY LICENSED' Budder's L~cense No ~ ~'~ .... Pinmber's License No ...... WITHOUT CERTIFICATr .... OF OCCUPANCY Other Trade's License No ..... Location of land on whmh proposed work will be done House Number Street County Tax Map No 1000 Section Hamlet Block . ..(3. ~ . Lot Subdivision ...................... Filed Map No .......... Lot .... (Name) State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a Exmtmg use and occupancy --~-~ ~--¢'-~.. ~~f~. ........ b. Intended use and occupancy . ...'dT~ .... --.~-- . / 3 Nature of work (check which apphcable) New Braiding .. Addition . .~'~. .... Alteration It , . Repmr ...... Removal .......... Demolition .... Other Work ..... (DescriDtlo~ 4 Estimated Cos · Fee ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... Number of dwelling umts on each floor ...... .' ...... If garage, number of cars ................. 6. If business, commercial or m~xed occupancy, specify nat, ute and extent of each, type of use 7. Dunenslonsofexistmgstructures, ifany Front .~.'~.,' ~ ' . . . Rear .~..a. p~ .... Depth . ~'&.' ~." . · I'~" ' ~ ........ Height , ~ ....... Number of Stones ! ~t, ............. Dimensions of same structure with alterations or add~tions Front ........... Rear .......... Depth ........ Height .......... Number of Stones ............ 8. Dlmensmns ofentlre new constructmn Front ....... Rear .. Depth .......... Height .... Number of Stones 9 Sizeofiot Front q~'~.'~,.. . ... Rear ~.O,~?..'' ...... Depth ~6f~,.'o,'~. . . I0. Date of Purchase ........... Name of Former Owner ................... 11 Zone or use d~stnct in which premises are situated ......................... 12 Does proposed construction violate any zoning law, ordinance or regulation ................ 13, Will lot be regraded ........... ,,,w. [ ,,.. ~ . ~ ~J, Vlll excess fill be remrlv~ f~om premises, ,Yes. 14. Name of Owner ofpremlses'~i]~f}~l~ .O{~4tn~l*~'q!J~ress ...~.~q~.~. !.'1' U°.~ Phone .am. Name of Architect .............. Address MIt*.~', ,~tl~l~.~l .~. Phone No ., . Name of Contractor ... Address aO~,~, . .............. Phone No /*... 15. Is this property located w~th~n 300 feet of a tidal wetland? *Yes ..... No ~ .... · If yes~ Southold Town Trustees Perramt maybe required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dnnenslons fron- property hnes. Give street and block number or flescnpt~on according to deed, and show street names and indicate whethe~ mtenor or corner lot STATE O~ NEW;Y~RK~k,~ t k- . S-.S = ~ ........ t'~.~q~ .'.. ~ (Name of individual s~nmg contract) above named being duly sworn, deposes and says that he is the applicant He is the .......................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and file this application, that all statements contained in th~s apphcation am true to the best of hts knowledge and belief, and that the work will be performed in the manner set forth m the application Fried therewtth, Sworn to before me th~s Examined ...... Approved .... Disapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802. (Building Inspector) APPLICATION FOR BUILDING PERMIT Apphcat,on No. / ~ q6 ~ INSTRUCTIONS a. This application must be completely filled ,n by typewriter or in ink and submitted in tnphcate to the Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of braidings on premises, relationship to adjoining premises or public or areas, and giving a detaded description of layout of property must be drawn on the diagram wh,ch is part of this cation c The work covered by this apphcatlon may not be commenced before ,ssuance of Building Permit d. Upon approval of this application, the Building Inspector wdl issue a Budding Perm,t to the applicant. Such shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or ,n part for any purpose whatever until a Certificate of shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordmm Regulatlons, for the constrtlctlon of braidings, add,t,ons or alterations, or for removal or demohhon, as herein des, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, admit authomzed ,nspectors on premises and in buildings for necessary inspections c.t. ......... (Signature of applicant, or name, ,f a corporal,o, .... ?. (Madmg address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or b~ Name of owner ofpremmes ~LOo .r~. D....~ ~ ./. ~-~ -/-/.~ ..~../'....97~ '. ...... (as on the tax roll or latest deed) If applicant is a corporation, mgnature of duly author,zed officer (Name and title of corporate officer) Builder's License No ."~.-~? .......... Plumber's L,cense No Electrician's License No Other Trade's License No ............. I. Locat,on of land on which proposed work will be done .............................. --fi~ .... .... 1< House Number Street Hamlet County Tax Map No 1000Section //'7 ........ Block.O~f ..... ... ... Lot..~.~.?--rv.. .... Subdivision . (Name) ' ' ' ~ Filed Map No Lot State exmtmg use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex,sting use and occupancy . iD.. (~.?..~. .... ?0-~ ~.' ............................ b. Intended use and occupancy . .C_~...L.o..~ ?_.15..c_...C~7,..¢~.. g~..e..,,~-.....6~..A.ZT.? .8...~./.w~.. ........ 3~"~Na'~uure of work (check which applicable): New Building .......... Addition .... X... Alteration .... :....-.. Repair .............. Removal .............. Demolition .............. Other Work ............... ~ o o (Description) 4. Estimated Cost../..;~...O.0..'..-T~. ........................ Fee .../~.~..~'~.. ............................. (to be paid on £fling 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 tyI~e,~p~£.use ........... ~ ......... 7. Dimensions 9~,e]~i.st!qgtstructures, if any: Front.. :~.~...~'~.~ear ... ~ .~?~ .e~l~....'~ep-~h . ~..~. ~ .~. ~'. ..... Height ....,~.~...'2 ..... Number of Stories .../../...~C~. ............................................... 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 Size of lot: Front .... q .~.: q:: ........... Rear...~..~..c'~. ?. .......... Depth .. ~.~..~.O. ~ .O.'~. ........... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ............................ Will excess fill be removed from premises: Yes No Name of Owner of premises .................... Address .~- ~'.~...~..,,-(..t~. ,./.--.~.~.~.. Phone No ................ Name of Architect ........................... Address ~ ,~-~ff4...,:/./: ... Phone No ................ Name of Contractor .......................... Address ........ /(~.~?.... . Phone No ................ 10. 11. 12. 13. 14. property lines. Give street and block numbeI interior or come_~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ~tion according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTY OF ................. S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, 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 ail 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 ............. .... ..... Qu~:f e:~ '"~ . -.::. .. ~. i// (Signature of applicant)