Page 1 of 2 BZY FORM City of New York Board of Standards and Appeals 40 Rector Street, 9th Floor New York, NY 10006-1705 Phone: (212) 788-8500 Fax: (212) 788-8769 BSA APPLICATION NO._______________________ APPLICATION FOR EXTENSION OF PERIOD TO COMPLETE CONSTRUCTION AND/OR OBTAIN A CERTIFICATE OF OCCUPANCY Section A. _______________________________________________ ADDRESS _______________________________________________ ADDRESS _______________________________________________ CITY STATE ZIP _______________________________________________ LESSEE / CONTRACT VENDEE _______________________________________________ AREA CODE FAX _______________________________________________ ADDRESS _______________________________________________ EMAIL Site Data _______________________________________________ OWNER OF RECORD _______________________________________________ AREA CODE TELEPHONE Section B. _______________________________________________ NAME OF APPLICANT _______________________________________________ CITY STATE ZIP Applicant/ Owner _______________________________________________ CITY STATE ZIP ______________________________________________________________________________ STREET ADDRESS (INCLUDE ANY A/K/A) ____________________________________________________________________________________________________________________ DESCRIPTION OF PROPERTY BY BOUNDING OR CROSS STREETS All sections must be completed _______ BLOCK __________ LOT _______________ BOROUGH __________________________ CITY COUNCILMEMBER ______________________ COMMUNITY BOARD NO. ____________________________________ EXISTING ZONING DISTRICT _______________________________ CERTIFICATE OF OCCUPANCY NO. ______________________________ ZONING MAP NUMBER (include special zoning district, if any) Section C. APPLICATION IS HEREBY MADE UNDER: Section §11-331 of the Zoning Resolution to extend the time of construction for a Major Minor development for a period of six months Section 11-332 of the Zoning Resolution to extend the time of construction and/or obtain Certificate of Occupancy for a Application Description Major development Minor development other construction for a period of months (see §11-322 for appropriate entry). P ERMITS (Consult instructions) 1. 2. 3. 4. Work authorized under Permit(s) No(s).: ___________________________________________________________ Type of Permit(s): ______________________________________________________________________________ Date(s) permit(s) issued: _________________________________________________________________________ Has the Department of Buildings notified the owner that the permit(s) lapsed? 5. No Yes, submit three (3) copies of such notice. Permit(s) issued based on plans filed under N.B. Alt. No. ______________________________________ American LegalNet, Inc. www.FormsWorkflow.com Page 2 of 2 You must answer the portion of this item appropriate to the section under which application is being made. You must describe in detail the work completed. Use separate 8½" x 11" sheets, marked “Item D” and attach sheets to each copy of the application form submitted. FOR AN APPLICATION UNDER §11-331 (Consult instructions): 1. Has excavation work been completed? 2. For a Minor development: The applicant states, upon information and belief, that substantial construction of the foundation has been completed as of ____ . (Minor development includes any Enlargement as defined in §11-31.) 3. For a Major development: The applicant states, upon information and belief, that substantial construction of a foundation has been completed as of . Section E. No Yes, Date: __________________________________________ FOR AN APPLICATION UNDER §11-332 (Consult instructions): For a Minor Development: The applicant states, upon information and belief, that substantial construction has been/will be completed as of ___ , date permit lapses. (Minor development includes any Enlargement as defined in §11-31.) For a Major development: The applicant states, upon information and belief, that substantial construction has been/will be completed as of ___ , date of permit lapses. 3. Section F. 1. 2. BSA History For other construction: The applicant states, upon information and belief, that substantial construction has been/will be completed as of ___ , date of permit lapses. FINANCIAL INFORMATION FOR AN APPLICATION UNDER §11-331: 1. 2. 3. Total value of construction for the foundation: $ . The value of foundation construction completed: $ . Irrevocable financial commitments on this work, including payments already made to contractors and others, in the amount of $ . (Itemize this total on separate 8½" x 11" sheets, marked “ITEM F” and attach sheets to each copy of the application submitted.) FOR AN APPLICATION UNDER §11-332: 1. 2. 3. 4. Total value of construction: $ . Total value of construction completed as of the date of filing: $ . Total value of construction expected to be completed on the date of the automatic lapse of the permit, if different from item 2, above: $ . Irrevocable financial commitments on this work, including payments already made to contractors . and others, in the amount of $ (Itemize this total on separate 8½" x 11" sheets, marked “ITEM F” and attach sheets to each copy of the application submitted.) I HEREBY AFFIRM THAT BASED ON INFORMATION AND BELIEF, THE ABOVE STATEMENTS AND THE STATEMENTS CONTAINED IN THE PAPERS ARE TRUE SWORN TO ME THIS _____ DAY OF _________ 20__ _______________________________________________________________ Signature of Applicant, Corporate Officer or Other Authorized Representative __________________________ Print Name ________________________ _______ Title NOTARY PUBLIC American LegalNet, Inc. www.FormsWorkflow.com