The URL can be used to link to this page

Home My WebLink About10445-ZFOI~M NO 4 TOW~; OF SOUTEOLD BUILDING DEPARTMENT 0ffic~ of the Buildln9 Inspector Town Hall Southold, 1LY. UPDATED CERTIFICATE OF OCCUPD~CY NO: Z-30133 Date: 06/24/04 HI{IS C~TIFI~ that t]~e btLildln9 DWELLING Leoation of Property: 640 SOU~ VIEW AVENUE (HOUSE NO.) (STP~ET) (HA2,ILET) County Tax Map No. 473889 S~ctlon 68 Block 4 Lot 21 Su/od/vision Filed Map No. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in th{s office dated SEPTES~ER 20, 1979 pursl~a/lt to wb/ch Buildin9 Permit No- 10445-Z dated OCTOBER 17, 1979 was issued, and conforms to all of the requirements of the applicable provisions of the liw. The occupancy for which this certificate is issued is SINGLE FAMILy DWELLII~ WITH ATTACHED TWO CAR GD/~AGE & WOOD DECK. NOTE: THIS UPDATES CO Z-11217 DATED 9/24/82 TO INCLUDE DECK AS PER APrE~rDED PLANS DATED 10/25/79_ · ~le certificate is i~ued to F_A_THRYN FARR3LND ( O~NER ) of the aforesaid building. SUFFOLI( CouiFrY DEPARTMENT OF ~E, ALTH APPROVAI~ 9-S0-87 09/17/82 ELEt-£~ICAL C~TIFICATH NO. N-494293 09/23/80 PLUMBERS c~TIFICATIONDA~'~U N/A Rev. 1/81 F~F~ NO. 2 TOWN OF $OUTHOL~ BUILDING DEPARTMENT TOW~ CLERK'S' OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF 'T, HE WORK AUZHOR]ZED) Permission is hereby granted to: ' ~/.~.~,~....~A~c/~.~.,~..~:... ......................... ~o ...c~.~..~ ~/~,~ ~...~.~ .. ..~ ~ ~ ? .~ .~ ,~/x ,~ ......................................... . ,,. ~ /~. - . ~.~ at premises locatedat~,...~.~ ....... ~-~ ~-~' ~' - .... ' ~**~.:,. ~ pursuant'to application dated ..~,~.T....~.~ ........................ , 19_~..~.:., end approved by the Building Inspector. Fee $~ .. ,~.. :,=.,r...~.A: ..... Building respecter Form No. 6 TOWN OF SOUTHOLD BUILDING DEPART3&ENT TOVt~ HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 11tis application must be filled in by typewrltcr or ink and submitted to the Building Dcpm/mcnt with thc following: A. For new building or new use: l. Fmal stawey 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 mid sewerage-disposal (S-9 lorn0. 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement fi-om plumber eer~if'fing that the solder used in system contair~ less tim 2/10 of 1% lead. 5. Cormnemial building, industrial building, multiple residences and shnilar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building 6. Submit Plannirtg Board Approval of cmnplcted site pkm re,qttk'emants. B. For ex%ting buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey o f prope~Xy showing all property lines, slreets, building and uausual namraI or topographic features. 2. A prop~b completcd applicatinn mid cousent to inspect sio~ncd by the applicm~t. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees / I. Certificate of Oc?~fipar~cy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25 00: Swbn mi ng pool $25_00, Accessmy building $25.00, Additions to acccssm'y building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Bnildmg - $100.00 3. Copy of Certificate of Occupancy - $.25 4. UpdatedCerdficateofOccupancy- $50.00 5. Temporat3, Certificate of Occupancy -Residential $15.00, ,Commercial $15 00 New Construction: Old or Pre-existing Building:: Location of PropeffLy: House No. Street Ou'ner or Owners of Property: , ,t,fi/ Suffolk Comity Tax Map No 1000, Section ~ 80 Block (check one) Lot Subdivision Filed Map. Lot: Date orPenrdt. /?,~7/7q , Applicant: Health Dept. Approval: Plann/ng Board Approval: Rcqucst roi: Temporary Certificate Fee Submitted: $ ~4'-d, a4) Underwhters Approval: ~FLual CertLL'~cate: (check one) ,,/ ~pp ~i'~cant Si~namre FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g. ! ~..2.~J. ......... Date ..... 8..ep.~.e.m..b.e?..2..~ .............. 198. :2. TInS CERTIFIES that the building .................... ' ............................ Location of Property ....6~.q. Soundview Avenue .P.o.C~.~... County Tax Mar No.~1000 Section . .//'~'~ ....... Block'./)A ........... qLot..0.2 t ............ Subdivision .... X .......................... Filed Map No.. X ...... Lot No. 7. ............ conforms substantially to'the AppliCation for Building Permit heretofore fried in this office dated .... ~..e p.g.~m..b.e.~..2.{)..., 19~9. pursuant to which Building Permit No .... 1.0.4..4.5..Z. .......... dated ...O.c.g. 9.b~i~.. ~.7. ............. 19 f(9, 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 ......... ..... ~, ~r.~y.~.~.e. ~, p~.~.-. ~.a.m.J,],y..d.w.e. ~. ~l.i.n.g, :. ~ ................................... The certificate is issued to .. g.o.b.~. ~.~..~, .. &..J.~ .a.n~o.. ~.o.~;o.~. ............................ of the aforesaid buildi~ig. Suffolk County Department of Health Approval .~ .- .8 .0.-. 8. .7 ~ . . 9. /. .~ 7/.8.2. ,~..R.q .17 .t,:..g. :. y.~k..Z.a~ .P UNDERWRITERS CERTIFICATE NO ......... 1~.~..4.9.4. 2. 9.3 ................................ Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF SOUTHOLD Building Department T~wmH~lll'- Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY I~ructions A This,,appf cat on must be fi led in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or n~w use: 1. Final survey of property with accurate ocation of all buildings, property li~es, streets, and unusual natural or topographic features. 2,Fine] approval, of Health Dept, of water supply and sewerage disposai-(S-9 form or equal). 3; Approval of;e ~ctricat nsta let on from Board of Fire Unde~riter~. ·' 4; C~n~cia[, bu~i~l~ngs~i l~d~stdaJ! bu'il~ing$, Multiple Re~'d'enc~s ,and,~ similar b?.,tldings and instalJa: t~ds, ~,~¢tificate o~f,C~de Cbmpi~a~C?,from the':Ardhitebt~ 0r, Eng'[neer re~po~!b'l'.e.for ~he building.~ 5; S~bm,i~t~n~b ,B'oarfl apprgvei~ o~ Completed ~[te ~lan requirembnts where applic~bm. E~. For existing bu, iJd'ings (prior to Aoril 1957)., ~on-conforming' uses, or buildings and "pre-existin§' land uses'. 1. Accurate survey, of peoperty showing ail property lines, streets, buildings and unusual, r~atu~a[;o~ topographic features. 2.Swo, r~.sta~ement of owner or previous owner as to use, occupancy and condition of 3. Date of a~ny ho,sing 'code or s~fety inspection of buildings or premises, or Other po- --tinen; 'nforma- ti~ dequ~red to, prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1 $5.00 Date .. L~/]~1 ¢;.2- New Building ...~ ....... Old or Pre-existing Building(:X) ......... Location of Property (2..~..O House No. Street Hamlet Owner or Owners of Property .~..~.~.P~.¢~..~. "~c..%~.?.~._.M_~k)~ ...... .~.~.----~..0..~. ..................... CountyTaxMap'No. 1000Secti0n .~,~_~. ,~_.. Block . ~ .. Lot~-..~,~- J~ · ...... Subdivision ...... .~. ......................... Filed Map No..~. ....... Lot No. ~ ........... -d0c ..... Permit Ne. J.<~..~.~.~'~. DateofPermitl.~t.~..l.q.~..Appticant ~.Q~.. '.~ .... .............. Heatth Dept. Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ~r..~..~..~.~..?..~. ......... Planning Board Approval ................... ~'-, Request for Temporary Certificate ..................... Final Certificate ................. * Fee ~ubmitted $... :~. ' .~- -~..~- ................. Construction on above described building and perm~t~mee~s all aPl~cable_,co,de~ and regulations. .......... THE NEW YORK BOARD O'F FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHIN STREET, NEW YOEK~ NEW YOR, K 1003~8 THIS CEEIFIE$ T~T in the followlng location; ~ Basement %~] /st Fl. [] 2nd Fl. Section Block Lot was examined on ~ ~ ~ ~ and found to be in compliance wigh the requlrernents of this Board. FIXTURE FIXTURES COOKING DECKS OUTLETS SWITCHES INCANDESCENT FLUORE$CENI S E C R V i I I~ T~[s certificate must not ~e alter~ in any m~nner return to the o~ice o~ the Boord J ncorrect nspecfors may ~e dentified b~ t~eir cre~enfJols.~ ~ LAWRENP. E M. TUTHILL Sept. 2~1~79 ~esidence - Hobert DeVoe S~r~view Avenue~ Pe¢onic Inside 70° Oatside 10° ';besi~ ~egrse clays 6,00e .~nsu!alion ,Urn '~oe$ ~o~r 2~ rigid, insul 38 F 147 (per,) 50560 Nalls P~!9 .04 1,846 Ceiling ~38 .03 1,~ ~rz~ows Dbl ¢~lass .69 418 Doors per coCe ~40 18 Iufilt ~io~ (volume) .018 17,400 2,~080 1%30e 48,810 Per cent glass 18% Eez~i~ w~ter li~s to be insulated as ~he~os%at as ~er code ~eather strippir~ all windows and doors Canlki~ as ~er code .ee~Ode cation. ahatl b, e. N~ State Name of If applicant FORM NO. 1 TOWN OF sOUTHOLD 5 BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 .... ) APPLICATION FOR BUILDING PERM IT Date gt:'?~ . O. ., 19 ?.~. INSTRUCTIONS must 'be completely filled in by typewriter or in ink and submitted in triplicate to the Building accuram plot plan. to scale, Fee according to schedule. location of lot and of buildings on premises, relationship to adjoining premises or public streets a detailed description of layout of property must be drawn on the diagram which is part of this appli- not be commenced before ~ssuance of Building Permit. of this apphcation, the Building Inspector will issue a Building Permit to the applicant. Such permit ,~ premises available for inspection throughout the work. shall be ocqnpied or used in Whole or in part for any purpose whatever until a Certificate of Occupancy the Building Inspector. [ IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Town of Southold, Su'ffolk County, New York, and other applicable Laws, Ordinances or of buildings, additions or alterations, or for removal or demolitiog, as herein described. sro cqmply with ali applicable laws, ordinances, build/rig 'cbde~ housing 'code, and regulations, and to buildings for necessary inspections. (gignature of applicanL or name, if a corporation) (Mailing address of applicant) is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ;...?.. ~ .v.~./c/.e..-~.. .............................................................. premises ...a.o.~..~.a..~...~..:Y.~ ~¥?. ~....~...¢X.~..a. ................................... (as on the tax roll or latest deed) rporation, signature of duty authorized officer. ~orporate officer) Ele n e ~''' ct i~.~Lic rise No ....................... Other I~ .License N6 ...................... House County 2. State on which proposed work will be done .................................................. ............. ¢.~..~h :~.l..4:~.... l~. v.~. ........... .P. ~.~. ?) .~ ....................... Street Hamlet ,No. 1000 S~ti0n ' .~..-].~/. ........ Block ... ~ ............. Lot ?..47...o..~...]..~. .... ,~..v!~ ....m~.~.d. 9..~..~ ......... Filed Map No./~A .~?.'5.~..~?.--... Lot . ../ ........... ~4ame) use and occupancy of premises and intended use and occupancy of proposed construction: : and occupancy .. M .~.C..hN"~-. .... .~J).~.~...' ............................................. ...g.e.o.9~..<~. ..... (~?. ~.4.~...% ~ [ ..... '.:p.~?..~.. ~.~..4.. 3. Nature of work (check which applicable): New Building . ~ ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~/ C (Description) (to 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 anti extent of each type of use . .-w. ............. 7. Dimensions of existing structures, if any: Front -- Rear .... .-77 ........ Depth...-': ........... Height ...... .--7 ....... Number of Stories... ~ .................................................. Dimensions of same structure with alterations or additions: Front -- Rear .....-"7. ............ Depth -- Height ..... .~: ............... Number of Stories.. ~ ............. ~2 ' ' '" 8. Dimensions of entire new construction: Front..~.°.: .......... Rear· .~O ........... Depth ~. Height ............... Nmnber of Stories ....~.. 10. Date of Purchase . . .~ I~?~C[ .w.'l ................... Name of Former Owner..~.~-.o¢.C~.~.... ¢~ .~-~?. I .......... 11. Zone or use district in-which premises are situated ..................................................... 12. Does proposed constriction violate any zoning law, ordinance or regulation: ......................... 13. Will lot be regraded ...~ ......................... Will excess fill be removed from p~em~ses: 14. Name of Owner of premises Ir, ~.~-9.. q.a ............ Address ~.~2-~..~3:...O. ~£'~. Phone No. ~ ~ .3 7.5.~..a.b. .... ~ ' Name of Architect . " . Address ~' . Phone No. Name of Contractor ....... :,,.. Address ~" Phone No. PLOT DIAGRAM Locate clearly 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. STATE OF NEW ~RI( :: -- COUNTY OF '. .... S.S ~ being duly sworn, deposes and says thane is the applicant ............. si~ning contract) .......... above named: .;~He is the .............. ~ ............. · ................ .. :,..., ............................ ,~-- (Contractor, agent, corporate' officer, ate,) of said owner or owners, and is duly authorized to perform or have performed the ~s~d~w~rk and to make. and file this applia~ition; tlfat all' statementi contained in this application are tree ~;o~Xhe best of l~o¢}ledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this · . , r 30. 19~ C0un~ ~ (Signature of applicant) GREENPORT NEW YORK SUFFOLK CO HEALTH DEPT APPROVAL THE WA*ER SUPPLY AN~ SEWAGI~.DtsPOSAL ~$~S FOR THI~ ~EsIDENcE WiLL , coNFoR~ TO- THE STANDArDs oF THE,, SERVICES . APPROVED; Tg~.5~gl L SUF;FOL.t~ CO~N~fW H. S. REF, NO.: C.O. TAX ~;T. SECT, ~OCf( P~L. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..~.1. ] '.4.1.?'. ......... Date ..... S. 9 p.t.e, ro..b.o?..2..4 .............. 198.2. THIS CERTIFIES that the building ................................................ · of Pro ert 6z~O Soundview Avenue Peconic Location p y ....................................................... House No. Street ' ' ' County Tax Map No. 1000 Section . .0,6,,'~ ....... Block . D.6. ........... Lot..0.£ 1 ............ Subdivision .... X ......................... Filed Map No, . X ...... Lot No. X. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... $ .e p.t.e.r~ip.e.~..;~0..., 197..9. pursuant to which Building Permit No .... 1.0. 9.6}~..g. .......... dated ...O.q ~. 9.b.a.s...17 .............. 19. T 9, 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 ......... ..... O..p.p. J, yg.he., pp.e.~ ~'g;n.J, ],y..d.u.e. ~. ki. qg, ....................................... The certificate is issued to .. lt.o. hq r' .~..~,. ~..49~rip, e.. 1~ ~.g. qe. ............................ of the aforesaid building. Suffolk County Department of Health Approval .9v.~.0.-.8. ?~..9./. .17./.8.2. :. UNDERWRITERS CERTIFICATE NO ......... ~.I..6.9.4. 2. 9.3 ................................ Rev. 1/81 Building Inspector THE NEW YORE BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 in the following location; [] Basement ~ 1st FI. ,~.sexa,,,i.edo,, Septeaber 18, 1.980 ~ 2nd FI. Section Block Lot and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES 49 44 45 49 DRYERS FURNACE SYSTEMS NO, OF FEET E S E R AWG OF CC COND 4/O NO OF HI LEO ~ A W G MO OF NEUTRAtSq A w O OF HI-LEG OF NEUTRAL 1~ 4/0 gal ~lg~a~ W~lgg~ae La. (~ceenpor~,N.Y. 11944 Lic. 1049 GENERAL MANAGER L1 This cerhficate must not be altered in any manner; return to the office of the Board if ~ncorrect inspectors may be identified by their credentials COPY FOR BUILDING DEPARTMENT, THIS ~oPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept, of water supply and sewerage disposa[-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4, Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5, Submit Planning Board approval of completed site plan requirements where applicab]e. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ail property lines, streets, buildings and unusual natural or topographic features. 2, Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3, Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3, Copy of certificate of occupancy $1.00 $5.00 Date New Building ....w~/. ....... Old or Pre-existing Building(X) ....... Location of Property ~.,~, .O House No. Owner or Owners of Property _ = fVacant Land '~ ........... ...... , ...... !'.o... Street Hamlet County Tax Map No. 1000Section .~)..¢],~: Block ~ ... Lot~jg~ Subdivision ...... .~. ......................... Fited Map No..~ ........ Lot No. ~ ........... Permit No. /.O,g.~.g,2~ Date of Permit 1 ,~. .... Applicant ....................... Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ~['J. ~ ,~..L?.~..?. '.~. ......... Planning Board Approval .................. Request for Temporary Certificate Final Certificate - Fee Submitted $ ~'~.~. Construction on above described building and permit'meets all app~cable_~code,s and regulations. ~'ho'x~z~,o Applicant.,.... d: i-'q ......... LAWRENP. E m. TLITHILL Sept. 25,1979 ~esidence - qobert DeVoe Soundview Avenue, Peconic Design temperature Inside 700 O~tside 10° Design degree days 6,000 Insulation "U" SF ~loer 2. rigid insul 38 F 147 (per.) 2nd flo~ 2-19 .05 104 Walls ~-19 .04 1,846 Ceiling ~-38 .03 1,144 Windows Dbl glas~ .69 418 (thermal) Doors per code .40 18 ~filt ration (volume) .018 17,400 BTU~HR 5,56o 2,080 17,300 43o 18, ,o 48,810 Per ce~t glass 18% Sez~ins water lines to be insulated as ~hermostat as per code Weather stripoing all windows and doors Caulking as oer code percode FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Exammed .;.? .... ,19 ? ? TEL.: 765-180 ..... lg?.¢..,'ermitNo. Disapproved a/c .. ~. :~ ....................... / Application NO~..O. </(...~..~-. '. ....... .~ ~L~,/,~_.~.z~ APPLICATION FOR BUILDING PERMIT , ~ , /~ / ~ /fi/_. . ~ ' . Date ~.~.~¢...~. ~ ~ / ~/d. ?.-- INSTRUCTIONS ~ /This appl~¢tion must be completely filled in by typewriter or in ink and submitted in triplicate to the Building inspector, with g sets of plans, accurate plot plan to sc~e. 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 eying 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 Pe~R. d. Upon approval of this application, Ce Building Inspector will issue a Building Pe~it to the applicant. Such pe~nit 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 sh~t have been granted by the Building Inspector. ~PLICATION IS HEREBY MADE to ~e Budding Department for the issuance of a Building Pe~ait pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re~lations, for the construction of buildlngs, additions or Mterations, or for removal or demolition, as herein described. The applicant agrees to comply with ~1 applicable laws, ordinances, building code, housing code, and regulations, ~d to admit authorized inspectors on premises and in buildings for necesm~ inspections. .... . .......... ;;.;:: .... (~ignat~e of applicant, or name, if a corp at' ) :. ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises . .~P.bq.&~. ~ 'T~ ~M(.- ~{~0 ~_ (as on the tax roll or latest deed) If applicant is a co~oration, signature of duly authorized officer, (Name and title of corporate officer) Builder's License No ......................... eh~mber,s ~icense ~..~/.67 .~. ~:; . . .~~' .... ..~ ./}.L:....~/~O Electrician s License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... O..2..5/. ........ Block . .. ~.. ........... Lot .~.4T...o. -.~...I..~. .... · · o,,~¢,t.v~ . OS..~..(q,c!.o..ug·5 ......... ~f..~..~..~ .~.~.. Lot.../. Subd,v~s~on ~O ............ Filed Map No ................ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...V../~.C.' .~.~.~f .... .L.0.M.~ ........... b. Intended use and occupancy ...~.¢p.~.r~ ~.~.b. .... ~¢~ ~c~-0o~-) Ct { ~ O~-td-} ~O F~ o 10. 11. 12. 13. 14. Nature of work (check which appl cable): New Building ,. ~ .... Addition .......... Alteration .......... Repair .............. Remow .............. Demolition .............. Other Work ............... Estimated Cost · . · .'~.Q.O. .~>. · · j ....................... Fe~../~..~._ ~_~ . (Dyscn.'ption) (to be paid on filing this application) If dwelling, number of dwelhng umts... Number of dwelhng umts on each fl Ifg I ' arage, number of cars ..... , .................................................. If business, commercial or mixed ~ccupancy, specify nature and extent of each type of use . ~- ... Dimensions of existing structures,.,if any: Front ..... 7'7. ........ Rear .... .-77 ........ Depth..~':. .......... Height ...... w-7. ....... Number of Stories... 77' .................................................. Dimensions of same structure with alterations or additions/Front -- Rear Depth ...... '7' .............. i. Height ..... ~ ............... Number of Stories....-~. .................,_ of entire new construction: Front. ,~.O... .......... Rear..~/O..........' ' ' J ' . Depth ~.O'.. £Cl~Kohoxo Dimensions Height ............... Number of Stories ....'~ ................................................... v Size of lot: Front ...-~ I .~.z...: .......... Rear .... ~..¢. ¢ .r ............ Depth . .7~..~). .~ .............. Date of Purchase . . .O. 1o7~-] 3.~J.. i! ................. Name of Former Owner .~-~.'~.a.C~..... ~9~.~. ~. ......... Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded .. ~.°. ..... i .................. Will excess fill be removed .from premises: Yes Name of Owner of premises .R, h~. q~ ............ Address ~.~¢-~a~¥ ~...Q.Rj£1A:.. Phone No. ~. ~ .~: .5.X .~,.b. .... Name of Architect " Address ~'. Phone No. Name of Contractor ......... ~:i ................ Address ...... ~: ............ Phone No.. PLOT DIAGRAM Locate clearly and distinctly all bujldings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block n~mber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N_EW ~RK,,' ~ _ '.e / 'S S ' d~me of individual signing contract) above named. .CH th els e ............................................................................. (Contractor, agent, corporate office~, ~t~.) of said owner or owners, and is du!y authorized to perform or have performed the said~work and to make and file this application; th'at all statements contained in this application are tree to,the best of lffi'~fiowledge and belief; and that the work will be performed in the mannqr set forth in the application filed therewith. Sworn to before me this ~ ' ~ ~.. ~ County , (Signature of applicant) :~ ¢~ >