Special Order Calendar (SOC) Application Form

Page 1 of 2 250 Broadway, 29th Floor New York, NY 10007 212-386-0009 - Phone 646-500-6271 - Fax www.nyc.gov/bsa SPECIAL ORDER CALENDAR (SOC) Application Form BSA APPLICATION NO.__________________________ Section A Applicant/ Owner _______________________________________________ NAME OF APPLICANT ____________________________________________________ ADDRESS ____________________________________________________ CITY STATE ZIP ____________________________________________________ AREA CODE TELEPHONE ____________________________________________________ AREA CODE FAX ____________________________________________________ EMAIL __________________________________________________ OWNER OF RECORD ________________________________________________________ ADDRESS ________________________________________________________ CITY STATE ZIP _________________________________________________________ LESSEE / CONTRACT VENDEE _________________________________________________________ ADDRESS _________________________________________________________ CITY STATE ZIP Section B Site Data ____________________________________________________________ STREET ADDRESS (INCLUDE ANY A/K/A) _______________ ZIP CODE _______________________________________________________________________________________________________________________ DESCRIPTION OF PROPERTY BY BOUNDING OR CROSS STREETS _______ BLOCK __________ LOT(S) _______________ BOROUGH ______________________ COMMUNITY DISTRICT . __________________________________ ZONING DISTRICT (include special zoning district, if any) ______________________________________ LANDMARK/HISTORIC DISTRICT __________________________________ ZONING MAP NUMBER __________________________ CITY COUNCILMEMBER Section C Description (LEGALIZATION YES NO IN PART ) Section D Actions APPLICATION IS HEREBY MADE TO: 1. 2. Waive of the Rules of Practice and Procedure (Explain in your statement) Extension of Time to: Complete construction 3. 4. Obtain a Certificate of Occupancy Expiration Date: _________ Amendment to Previous Board Approval Extension of Term of the: Variance Special Permit For a term of ____ years Expiration Date: _________ 5. Other (Explain in your statement) Authorizing Section(s) of the Zoning Resolution: § 11-411 § 11-412 § 11-413 §§ 72-01 and 72-22 § 73-11 Other _______________ American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Section E Department Of Buildings Information 1. Have plans been filed? ................................................................................................... 2. Have plans been approved? ............................................................................................ (If Yes, Date Approved _______________________) 3. Has a permit been obtained? ........................................................................................... (If Yes, Permit No. ______________ Date Issued _____________________) 4. Is work in progress? ........................................................................................................................... (If Yes, Percentage of work completed __________%) 5. Has a temporary or permanent Certificate of Occupancy been obtained? ........................................ (If Yes, Expiration Date _____________________ Attach a copy) YES NO If you have answered "No" to any of these questions, include a paragraph in your statement describing the reason(s) for delay and the projected schedule of completion. Section F Board History List all prior Board actions associated with the subject Zoning Lot and attach one copy of each resolution: On _______________________, when the Zoning District was ____________, an application was granted by the Board under Section __________ to permit: Section G Inspection and Compliance 1. Have you reviewed the Board's case file? .......................................................................................... 2. Have you recently inspected the premises and surrounding area? .................................................... (If Yes, date of most recent site inspection___________________________) 3. Did you find: a. b. Compliance with the terms and conditions of the Board's resolution? .......................................... Attach a completed Certificate of Inspection and Compliance Any significant condition changes (e.g. rezoning, city map amendments, recent developments) within the affected area since the Board's last action on this application?............ YES NO If the answer is "yes" to any of the questions below, explain further in your statement. 4. Is there currently a proposal before the City Planning Commission to change the subject Zoning District, or any other action which includes the premises? ............................................. (File / CP No. __________________) 5. Are there any outstanding violation(s) on the premises? ...................................................................... (If Yes, submit a DOB BIS printout) 6. Is there any other application before the Board which affects the premises? ....................................... (If Yes, Cal No. _________________) 7. Is there any other application at any government agency which affects the premises? ....................... Section H Signature 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