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Home My WebLink About11685-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 10/17/06 No: Z-31917 THIS CERTIFIES that the building ACCESSORY Location of Property: 1950 BREAKWATER ROAD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 106 Block 9 Lot 6.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated pursuant to which Building Permit No. 11685-Z dated MARCH 21, 1982 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 ACCESSORY STORAGE SHED AS APPLIED FOR. The certificate is issued to NORTH FORK GREEK COMM ASSOC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. H-055726 06/18/97 PLUMBERS CERTIFICATION DATED N/A ~~re Rev. 1/81 ~':f.' ,.,::;",;:,)'y,:,';:y:,','".rw,.jl'.!'JIIJ~'_'~','''.~'1I';,;:f,:;9~~}>":'F'\~?:1.,,,,,,,-"~'~~-~t"';.n!l;'J:"]'m,~;,,",(-\i!.~eI?.1~_~1TI-~;~f.:<<J:(""=t:_~~7\h""~'''~~''''''0~,:~#,,,,'r'-''';/'~ni~'~~7;i~1 .~.' " . .~" . .". . '.' ",R'm!",=~_ _~~_~,~_~~~"t-"::'''7.~''' FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING P.ERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 111)85 z )/1/1/1;)-/ ?;;J..... Date ........................................................, 19....... . Permission is hereby grante~ to: / IJ"JP )/'ri,,f -=1"Y"'(rnu," . ;f.u-tl C ~ L r".APl) . ................................................................................ ~ f , ....~~;:?~JS~.~~~ ~;~~7hu,~ ................................................................................ to .....~~.....~...........:.~.~.:..~Z........~.~.'::~......,,:.4.'!!.'!...~.'..~1.............................. II'" ;"4. ................................................79'5(j.......~;;.X;~.~Ti;"...........;B~.J............................ at premises located at .......................................l;p;;;~.;.l......................................................... ................................................................................................................................................................ ~~~~~.~~~..~~~..~~:..;.~~~..~~~~;~~..::::::::Ze..?~.....~.I:~..:::::::f::::::::::..~~..~~:.........~.;...l....................... pursuant to application dated ...............................(!r........~(.., l~.~nd approved by the Building In:pse.or. If) Fee $........................ ~~~ ................................................................................ Building Inspector Rev. 6/30/80 ....., ~' (; _~-1 ,-' n \". r:: \" '\ r ,. . ? a~ - 5 J ;).7 , Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 8 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. 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 211 0 of 1 % lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B, For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building mspector 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, 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 - $.25 4. Updated Certificate of Occupancy - $50.00 5, Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. / O/~/b &. New Construction: Old or Pre-existing Building: (check one) Location of Property: /900 6rP4/'~//)/~R .Ko, 4.4:J...k:h/"; .4,,/ House No. Street / Owner or Owners of Property: 1/J1hv}. rlF c;{ns'T tflt2tf..er (f!httl<fx c4pf('A Suffolk County Tal' Map No 1000, Section /0 i d Block ,7 ~ Lot / I ? S-d.- Hamlet 6- / - Subdivision Permit No. / /0 k pf Filed Map. Date of Permit. Sf 1/82 Applicant: Underwriters Approval: Lot: Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ifr;'P~ fm.JCertifi~~ ~ 'ohocko"o' . ~v~L Applicant Signature ~.uc.,/rIOo cO:C3\QI7 /I~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] I~ULATION [ ] FRAMING [ v('FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ()~tF C 01 ~ ~g,~~A ~~:e>, DATE f;P"h7 I INSPECTOR ~1f1L NEW ,",ORK B F FIRE. UNDERWRITERS PAGE 1 0.", JUNE 18,1997 THIS CERTI~IES THAT ....". .".....trIceI "'."....... . rl_ -.. _............... "" .". .,..,_.............". ....,.,t,.,.- ..u............ ,.........,-J BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NY 10038 13900097/97 .4ppIlea.,- No. 0./11. H 055726 TRANSFIGURA'l'ION OF CHRIST, 1950 BREAKWATER RD., GREEK OR'l.'HODOX CHURCH, HAT'l'ITUCK, N.Y. "'.".!oI""""'......,..., 0 _....... 0,..11. 0,,,,, 11. GAR .'W...... Bloc. Lor _......_... JURE 11,1997 _fb_If>..IIr.-,u-"_...N____~ IIXrua CIUtII1S -- ""~ntr- "lI1CNICWf ....... NAT. <.W. NAT. IlICItI ..w. 0_ AMT. Il.W. - NAT. <.W. .T. .... . - MT. LW. 9 . . IWNACl.o1OII __ _ .-.r llMIaacu _ IINIT.__ ~ DIM_ ON. K. Po OM ... Po NAT. NO. A. w. a. AMI. MI. AMt. AMPI. tuNI. AMJ. k Po NO. Of .... NAf. WAm IBYICI DItOVI..CT AMt. ... . 1WI . . or ...... . w V I NO. or ....... c w . NO. or ......... __liiio GARAGlHXI'l' BUllDIBG-1 PAHIlLIlOJ\IlDS.1-6 em. 100 G.F.C.I,-1 1hII _IJIk.AL....... ft!l'I .-t _to ... ..... .,_ LlL GRIIIK OMlllDOX CHUIlai 1950 1lRDJOIA'!'IlIt ROAD POBOX 1162 HA'l"l'ITUCK. NY, 11952 ...~, ...,.. ." ". . ' COPY FOR'8UILDII5,DEPARTMENT. THIS COPY OF CERTI..ICAT~ III$T:"'"'.ALTERED IN MY _ER. ," :i. _,... i .LL"'... i;.", ,'., _'~ ,'- .-.":~,,,,~'--Li.i.-l!.,.;..w.-. '...... '. ~""_"' ." 11 .'Pw /../,\ _ ......AI""" thoIr .......h. ~- --..;....:........:..:._:~.;....:.:....I ..~~-:.;.~.:..=-..-_..__._. . .. ....---.--.-..-- -. ... .~., FORM NO.1 TC'/IN C:= SOUT:-iOLD BUILDING :::lEPARTlviENT TOWN HALL SOUTHOLD, ny. 11971 TEL.: 765-1802 Examined.......... .~.., 19~ . I' 10 9-" 'J-7 Appro\'ed . . . ...... .. .7':1.,19. .. PermIt No. . . ....... .. /"" Application NO/(~.~~....., Di,approved a/c ..................................... .......................................~}.~~ ....v........ ................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . 4Ql~d... .?-/. ..", 1~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. PI0t plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre or areas. and giving a detailed description of layout of property must be drawn on the diagram which is part oHhis ap cation. c. The work co\'ered by this application may not be commenced before issuance of Building Permit. d. Upon apprc:al of this application, the Iluilding Inspector will issue a Building Permit to the applicant. Such per: shall be kept on the premises available for inspection ~hroughont the work. e. No buildi:Jg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupa: shall have been granted by the Building Inspector. APPLICATION IS HEREBY M^DE to the Building Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinanee~ Regulations, for the conslruction of buildings, additions or alterations, or for removal or demolition, (IS herein descril; Thc applicant agrees to comply with all applicable laws, ordinances, building codc, housing code, and regulations, and admit authorizcd inspectors on premises and in buildings for necessary inspections. t?/o ~II'RI$, 01$ 1?Q &~q , , .:2'l8' ~ t.t't 51 Ft.. ESS AS t'1 AIfi l "'TI.I t. Ie( 1(952. .1JJ.llft!~! f.~bi/f2:thl iN. ~f. ~/!f..!.~.r:......., (Signature of applicant, or name. if a corporation) bJl~ Of..1'HofW( C.f'f1/f2-tf,HAT1/1/)(/ . . . . . . . . . . . . . . . . . . . . . . . . . . . .~. . . .. . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, arc~litect. engineer, general contractor, electrician, plumber Cor buile . . .C. /:i.:-{ .tlC-.. tf. .. ,13.J A1). 0.. . . I).F:.. .~ ! fl. q!p.~.~. . . . . .. .. . . .. . . . . . . . . . .... .. . . . . . . . .. . ' . . .'. . .. . . Name of owner ofprc~ses,' :n~~ ~.~ F.Z~'~ !i.a.~. . <;J.f. .<;~/) r:. .C; .~r!_/ .t!... '. 11.4 TJ).r:r;f-.~..-. . ~ M ~ ~, <-k (as en the tax roll or latest deed) , If applicant is a corporation, signature of duly authorized officer. ........ ..... ......... ...0. ............ ....... (Namc and title of corporate officer) Builder's License No. . DI'J.. (T.. ,t:?!4,iR$.~f:~~--?' N (I ff i f2...(N C; Plumber's Licens~ l"f.I. .....~ ~ !'-!.f. . . . . . . . . . . . ~ . EI t" 'L' N' N iJ tv t:: ::c rlClan S lcensc 1 '0. ...................... Other Tradc's Liceilse No. .... .N.o. N.~. . .. . . . . I. Location of land 011 which proposed work will be done. . .8!c t; ~1< It{ ~ . P:-~).. . . /':f. ~-:n?Y~(~. '!!:Y. ... .!.~?t?.... .l!!:~~~.t~~~~..... ~~:'.?.............. ~~~'.:'!.~.~'(....... House Number Street Hamlet County Tax Map No. 1000 Section .......1 f? .ri?.. .. DIock ....... .c;.. ....... Lot...:i.... ~ ~./.. . Subdivisioll . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed ~lap No. .............. Lot............. (Name) 2. State existing lIse and occupancy of premises and intended LIS'\. and occupancy of proposed construction: a. Existing use and occupancy .. P.~~.q .. . .1) F. . ~ .'J. p:" ?ifJ./:. . . . '\. .. . . . . .. .. .. . .. . .. .. . . . .. .. . . b Intended d rpf,(Aa fii{.l Sllefli~.:"(AiVi! 81\J'Ph8'J~ ..' ,'......:_ . use an occupancy ...;;;"1 .,,'~; . . .. . . . . . . .. . . . .~ .. . .. .. . . .. .. . .. . .'.... . . ..;. .';' .. .. . .. .. . .. .. .. .. .. .. .. .. . . .~. . ~. . ,..~~~~~.~:.:~::}fDo-:c.;.: . ;.,'~::-;~ ;:--.~ ~_ ~ '~~,' .' .'<;.<'; " 3. Nature of work (check whid' applicable): New lluilJing " .~. . .. Addition.......... Alteration ..... ~ . . Repair .............. Remo'..al . . . . . . . . . . . . .. D~molit;cn .............. Other Work. . . . . . . . . . . . . Estimated Cost. . . . f(..q ~ :J. . . . . . . . . . . . . . . . . . . . . . . . . . .. Fee . ./Ji. r. . . . . . . . . . . . . .(~.e~~r.i~~i~~~ (to be paid on filing this application) S. If JwdJjn~, number of dwelling units.. . . . . . . . . . . . .. Number of dwelling units on e~ch floor. . . . . . . . , . . . . . If p,,;e, number of cars ...................................................................... G. If business, COl:l:nerciJl or mixed occupancy, specify nature and extent of each type of use. . . . . . . . . . . . . . . . . . . ". Dimensions of existing stmctures, if any: Front. . . . . : . . . . . . . . . Rear .............. Depth............., Height ............... Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' Dimensions of same structure with alterations or additions: Front ................. Rear................ DD~Pth ',' .. . '1:' 't: . . .. 'c' . 's't' . 't~ieigJflt . 't' " '):0; . . . . .. . . 'R' . . Numb~g~ Stories. 'D'e'p'th' . . 'j 0 .,. . .. ...' ll. ImcnSlOns 0 '~n tre new on rue Ion: 'ron ............... car. . . .. . . . ....... .... . " . . . . ... Height ..1'1:...... ...NumbcrofStories.... /....................... ..:.. ......... .....j.. '00.. 9. Size of lot: Front.. .(~t1'" :........... Rear.. ..(lo.:............. Depth..... .t. ./.fJ..... H.. 10. Date of Purchase ..1.......................... Name of Fornler Owner ..........,................. II. Zone or use district in which prcmises are situated...: " .'... .. ........ ... ........... ."......... ........ 12. Does proposed construction violate any zoning law, ordi.lance or regulation: ...~ -? . . . . . . . . . . . .. . . . . . . . . . . . n. Will lot be regraded . .~9.... .'................. . WiI! excess fill be removed from premises:' Yes N (4. Name of O.....ner of premises. . . . . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phonc No. .. . . . . . . . . . . . . Name of Architect .........................'.. Address. . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . .. Name of Cont'ractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address ...... . . . . . . . . . . . . . Phone No. .............. 4 PLOT DIAGRA.\f .... Locate clearly ::nd distinctly all bui!dir.gs, whether existing or proposed, and, indicate all set.back dimensions fro! proi'crty lines. Gh'e street and block nun,ber or description according to deed, and show street names and indicate whethe .nterior or corner lot. SiZE A7Tf!UI~-v bRI1&JIJJ6,> , S.S .. .~ ....~.......... (Nanie of indi,'idual signing contract) abov'~ named. fjejsthe.....~..L_... being duly sworn, deposes and says that he is the applican ..... -~'.. ~.~.Y/~G~ (Contractor, abent, corporate officer, etc.) a ,,-r said owner or own~rs, and is duty ~llthorizo:d to perform or have perfonn~d th~ said work and to make and file !hi application; that all st:It':m~l\ts conraiiled in this application arc true to thc best of his knowledge and belief; and that th, ~ork will be performed in the manner set forth in the application filed ti'crewith. Sworn to before mc this , , . . .tlayof . . . _ (fl: " A ,0 ,) . . . . . . .. 1 ~af.-.. '~/~ \ COllnty 0 .0. (~u;.1.3;) ~ .1& ~.~~~...... .......' , , (signature of applicant . ~.' '~ " .~ .': . No. 52-81258 0, StlffClk'~r . T<ltm fIopi,.. Milt/! 30, ~. - . . - . . - . - - -- .:;:-:.....:- ~-,~~.~.:.- -~~ ..t. ---'-'--. . _. --. .-.--. --..----. 1iJ~d~-~~.S4~~' FORM NO.1 TC,'/N c;: SOUT:~OLD BUILDING ::JEPARTl-iENT TOWN HALL SOUTHOLD, ny. 11971 TEL.: 765-1802 E.uminCtI...........?~..19~. If ~t--!>-7 Appro"ct! ... .... .. .. .7.1..19. .. PWl11t No. .. ....... .. -- Application No/(~.f.~,..... - Di"pprovet! a/c ..................................... ................................::::~/~}/.~.. (Building Inspector) ()' 0<) U'\ l'\i APPLICATION FOR BUilDING PERMIT Date .~I?(L. ..?/....,' 1~ INSTRUCTIONS a. This application must be completely filled ill by typewriter or in ink and submitted in triplicate to the Bui:, Inspector, with 3 sets of plans. accurate plot plan to scale. Fcc according to schedule. b. PIGt plan ,howin~ location of lot and of buildings on prcmises. rebtionship to adjoining premises or public str or are;ts, and giving a dctailed description of layout of property must be drawn on the diagram which is part o/"-this a~ cation. e. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc:al of this application. the Building Inspector will issue a Building Permit to the applicant. Such per shall be kepI on the premises available for inspection Jhroughollt the work. e. No buildi:Jg shall be occllpied or llsed in whole or in part for any purpose whatever until a Certificate of Occupa shall have been granted by the Building Inspector. APPLlCA TION IS HEREBY 1-.1ADE to the Bllilding Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of SouthoId, Suffolk County, New York. and other applicable Laws. Ordinance Regubtions. for the construction of buildings. additions or alterations. or for removal or demolition. as herein descril The applicant agrees to comply with all applicable laws, ordinances, building code. housing code, and regulations. m, admit authorized inspectors on premiscs and in buildings for necessary inspections. t% CitR/57 OJ;. f:Q &~1 . I ~8"~ t.tlf51 FL- ESS AS 1'1 AIfi l \\J t '< If952. .1J!/JiI!r;!F.~Gvr-:tf1I iJ.1. ~ f. ~/ff..!)r. . . .. . . (Signature of applicant. or name. if a corporation) 6!l.wt. OR.~bbt C.tfvf2..tf,;lIAT1t1l)C ....... ................................. ..... (Mailing address of applicant) Slate whether al'p!icant is owner. lessee. agent. arc~litect. engineer. general contractor. electrician, plum ber or buil . . .C. i+I fi. i:. t1. . . . '1$." A1). F). . . .9 F. . .~ ! (2. ~!P. ~'.~. . . . , . . . . . . . . . . . . . . . . . '.' . . . . . . . . . . . . . _ . . .'. . . . . Name of owner of prclll<ses .. 7P:~ ~.~ F.(W.r!-.~TJ.O.IoJ.. 9,f. .~tff:~~ r:. .C; .tf:ti.(l/ .t'!. . .: 11.4 m.T:Y f.-./{... :. 'Jj;r.-# ?t4 ~..&J" ~. ~!C ~'C (as en the tax roll or latest deed) . If applicant is a corporation. signature of duly authorized officer. ~ ;f C!. t. () to .~ ~ 1I1 c: "\70 1- (J ':f. . - -- ~ l:::, Olher Trade's liceilse No. .... .N.o. IV.~. . . . . . . , ~ C. 1. Location of land on which proposed work will be done. . .6!C ff':---l< It{ ~ . (2;-!).. . . 1'1. f:CTI TY.~(~ .r.t:7 ....!.;?,?P.... .l!!.~~ ~ .t~~!.~7.\... ..'~~::!:............... ~":'.. .f!.',:'!.~.':(......, House Number Street Hamlet /D /:. .......,CJ......... Lot.. 'v,i.. ..'.'.<'..(... County Tax Map No. 1000 Section........... .<t!..... 1JI0ck l ~ . ................... ......... .......... ....... (Name and title of corporate officer) B'ld . L' N Q", IT. ou,oScLIIE..5' UI er S Icense 0.. . Y. . . . . . . .':--" . . . . . . . .. . No Hi~IN(; Plumber's Licens~ No. .... .~q !'!.f....... ..... ~ . El .., L' N' N " tv C .:;ctncl311 S lccn~c 1 O. ........ C: . . . . . . . . . . . . . . Subdivision. . .'. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .. Filcu :-Olap No. .............. Lot............. (Name) 2. State existing use and occupancy of premises and intended us'\. and occupancy of proposed construction: a. Existing use and occupancy.. p.~~.c.-f... .OF.. N.~.{{?!!Jj:... -"I...............;.........:.... ........,._...::......:...,...,b.... Intended use and occup'ncy rp t;?,~ c;;:t y.:;ia::Sllf f 1I't~.'l:'.> .<1 ~ Jr 81'J I Ph 8'J -r.: -- - ... .. .. :::"J .'-.' ~"; .. .. .. .. .. . .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. ._. .. .'. .';.. ._. .... .. .... .. .. .. .. .. .. .. .. .. \ '-J _ ..''''.''..'" ,.:~).."..,.:--:,,;;:~': - .. ,0:-_;,.. ~o~:_ 3. l':ature ofwod: (check \Vhid' applicable): New lluilJing .. .~. . .. Addition.......... Alter:ltion ....... Repair .............. Remo"al . . , .... ..... .. Dcmolit;cn .. .'. .. . . . . .. .. Other Work..... . . . . .. . . Estinla[cJ Cost. . . . '~"~ 1 :J. . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee.. !Ji. F. . . . . . . . . . . . . . . .(~.e~~r.i~~i~~. (:0 be paid on filing this application) 5. If Jwcllin~, number of dwelling units.. . " . . . .. . .. " Number of dwelling units on e~ch floor. . ..... . , . '" , If gar:!cic, number of c:trs ............................................................. .0.. ..... . G. If business, COl:l:l1ercbl or mixed occupancy. specify nature and extent of each type of use. . . . .. . , . . . . . . . . . . . . ". Dimensions of exist in; structures, if any: Front. . . . . :. . .. . . .. . Rear .............. Depth..... . " . . '" Hei;;ht ............... NUlllber of Stories. . . .. . . . . . . . . . . . . . ... . . . . . . .......... .. . . .... . ........ Dimensions of same structure with alkrations or additions: Front ,................ Rear................ Depth.. " .. . .. . . . . . . . . . . . . . Height.. . .. . ... . .. . . " . .. . . . Number of Stories. " . . ... ...... . ..... g. Dimensions of ':ntire new construction: front. . .-?-.I~: . . " . ... Rear....?-,q ~..... . . Depth. . .~ f!:. ..... . Height ..1'1;"....... Number of Stories . .../.... ................... ....................i. ..... 9. Size of lot: Fro:!t .. '(~~i1'" :.'......... Rear.. ..1./0.:............. Depth.. ...... .1(,).... ...'. \0. Date of Purellase .. f. . . . . . . . . . . . . . . . . . . . . . . . . . N:;;me of Fornler Owner ..........,................ II. Zone or use distrkt in which premises are' situated . . . : . . ,'. . . . . . . . . . . . . . . . . . . . . . . . . . . . :'. . . . . . . . . . . . . . . . ,'2. Docs proposed construction viobte any zoning law, ordi.lanee or regulation: ...J!-< Y. . . . . . . . . . . . . . . . . . . . . . . . n. Will lot be regraded . .1--:~.... .'....... .... ....... Will excess fill be removcd from premises: Yes, J 14. Name of O'-':ner of premises. . . . . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. ......... . . . . Name of .,\rchitcct .........................'.. Address ................... Phone No. ..... . . . . . . . . Name of Cont'ractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address ................... Phone No. ............. of PLOT DIAGRA.\f .... Loea te clearly :md distinctly all buildings, whether el:isting or proposed, and. indicate all set-back dim cns:ons fre proj1erty lines. Gi\'e street and block number or deSCription according to deed, and show street names and indicate whetJ- ,,,terior or corner lot. , SiZE A7Tr.UiE::-)) ~RI'.M~.J6> . S.S :'. '. . J~. . . . . . . . .. being duly sworn, deposes and says that he is the applical (Nanie of indil'idual signing contract) abo\"~ namcd. Heisthe.....JL~..L.... ..... ~'-.~.v(.'-'G~_. (Contractor, a!;ent, corporate officer. etc.) 0 "f said owner or OWllCrs. and is du!;- :Ill thori7..:d to p~rform or have performed the said work and to make and file th n/lplication; rJlat all st:It':ments cOnl:liiled in this application arc true to the bcst of his knowledge and be lid; and that tJ- ~ork will be performed in the manncr set forth in the application flied l:'crewith. Sworn to bdore me this . . . . . . . . . P.-.-f{ \ d..; . ..d-~of.... (p' '" A.~ 0......., )9k~ '~/~ \ County .' ..J U--r..' ~,<>--. .JJ tb. ~ . No. 52.!I258 O. Soff.lk'~ .(,'1 . . . . . I-v.?:"V-v . .r. (. :-; i ,. ::._;>-". . . . . . . . . . '.' . T"~ ~Ir~so M~th ~. ~/ o. 0 0 ~ . (SIgnature of annli~'H' . o .__ c ~Oo 00 "~~-::-~'~-'o.:o:o'_';"'o: ~._o_o:~,i. '0,__0- ,-, -.-.-'" . .. . , <;(oIW,,[ " U IL/)l rJ G (tSPH':!..T SIf"J6lu "~''''.'',v 2~1-Lf" tJ-' oc. )."I,~" C:J il<Bf~1~5 SHIN6([S :l- " 'j ----. 2",,11," (o,,,e. fDOfliJ6 <:: ~u' t I , I RI 1 l-t)6\T' DI)\j::~.r :.'.-" ::' i'. g" Rlu(,[ IJ. 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