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22984-z
r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23955 Date OCTOBER 17, 1995 THIS CERTIFIES that the building ADDITION Location of Property 2055 BAY SHORE RD. GREENPORT, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 53 Block 4 Lot 12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 18, 1995 pursuant to which Building Permit No. 22984-Z dated AUGUST 31, 1995 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR & AS PER ZBA #4324. The certificate is issued to RICHARD MAUTNER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-365638 - OCTOBER 5, 1995 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD,N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ......... 3 J........................................ 19.. NS' 22984 Z Permission Is hereby granted to: Jo/.f"1.............r is / �,/G........... .. .......... �'Mn....eysc%a........2i�� ................................... r / .��✓ i9 �... to .... .... T�lGc�c�.............��......... f-r-�G....... ��!/� /........................ ............................11.//.. / ��...� .....'.�.....i......... � � M. - ..... �l ol/...s.......................... ...........................................................I................... atpremises located at.... © `s �! J ��............. ........ ............................................................................... ....................... ......................... ,✓ ° ................................................................ , ............ County Tax Map No. 1000 Section .......J�.-3............. Block.....0�............ .Lot No. ....../ .............. T �� pursuant to application dated .... .!!� . ..1....� ............................ 19...� ., and approved by the y Building Inspector. Fee$... ..... - / ... "? � ............................... Building Inspector Rev. 6/30/80 Form No. 6 TOIM OF SOUTHOLD BUILDING DEPARTMENT TOTM HALL 765-1802 APPLICATION FOP, CERTIFICATE OF OCCUPANCY A•: This application must be filled in by typewriter OR ink `:and submitted to the buildin inspector with the following: for new building or new.nse: g 1. Final survey of property with accurate location. gf all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supp.,y and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying thit"the solder used in system contains less than 2/10 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: 1. Accurate survey of property showingall 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 dwellin • Alterations to dwelling g $25.00, Additions to dwelling $25.00, g $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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential�$15.00, Commercial $15.00 / Date . . . ��Ji:vthe `; , . Iq� New Construction. . .... . . , Old/Or Pre-existin Building. • • • • • • • . • • • . • • . Location of Property. . . .SJ, , , , , , •„ • . . • j • h� . • • . �f � • O House No. =�• . . . . . . ... . .�'. . . . . Street Hamlet Onwer or Owners of Property. . . . . 1� (�lCocJ, >, , , .6� �tiry . County Tax Map No 1000, Section. . . ,��-3. . . . . . .Block. . . � Lot. . •�Z. . . . . . . . . . . . . . . /�C. . Subdivision.&I.i 1_. !J11. . ..� . . . • , ,Filed Ma�. . . . �� .Lot. . . . . . p. . .� .Y. . . y. . . . . . . . . . . . . . Permit No. . . ZZ f', ,! , , .Date Of Permit. . . . . . . .Applicant.J0.6'.n. . :iealth Dept. Approval. . . . . . . . . . ... . . . ... . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Tanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . :tequest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . 'ee . . . Submitted: $. . a . . . . . . . . . . . . . . . . . . . . . L a39S.�. . . .APPLICAN o��g�fFO(�-co c� GZ� y Z Town Hall,53095 Main Road 0 • Fax(516)765-1823 P. 0. Box 1179 y� O� Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD September 15, 1995 John Bertani Builder Inc. 1380 Oakwood Drive Southold, NY 11971 Re: Mr. Richard Mautner - SCTM#1000-53-4-12 Prem: 2055 Bayshore Road, Greenport To Whom This May Concern:' We are unable to complete your Certificate of Occupancy because of the following reasons : An application for Certificate of Occupancy is not on file. (Enclosed) . xx No Underwriters Certificate on file. The check is (outdated/not on file. ) $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 22984-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. a s JOHN BEEF', NEW--YCFRf .NEW llt'RK 10038 � Date OCTTOBER 05.,1995 dlpir►ficatian tiae..osa�e 1$3155��f9� .....- ._ �. .__ N 365,38, THIS CEFMFiES THAT the of i equspra "as J—ma�44.mad iwtr"Awcalt by rj6w BppCac�atis Jsaaiodas tAe a6aaR aasm6e r in c]�e ,, in tkefonewiragkwarian; X Sussman. W.H. C Yad R. OUT. _ ------ 5 " $tocf ~ Los - A mWN-exa minto rift SEP`PEMBER 18 r 1995 .aud -nd to be in ceMPHance wiM the Nalloraad Reicvwai Code. - - li7[TUIP ' FUITUNES UMM Lc0G m DE+m YENS WASHM I E H A W F4 aura" �IIITGtES cesaena ptu0"gcEw arwem ' ANW4. r_W. •xT a.W. AML- a w_ .•-ART. :x W. iuMt. ' is e • .. 1 _._ 3 Dil0 ms i -RNNACE Al OUM itJRf M APPUM = NEOM 466ALREC" TNNE CLOOM u3,L 1J/A�t�icT85' 1�9UTIt:T i- ... `. : K.W. oa K F. GAS a F. AMT. A.w_G. T j Aar, _ rrrs. Titl1[i5= .aAAT. I:v_ rp 7. ......................L SER1 q�tELT of S E :..r .. r C, F , AIAT, Aw. 77HE - i.l"7W T j`3W ]d 3N' 3l JW NO.of CL O�!!0.. .�.W.G. - "2�0.#MFIEG A.W_`G.-� .E7JO Of IElJ1WhL5=- ,A,AL G ':- AE(t i OF CC.tONR - OF_ OF 7+&MM.-- OTHM:NPAtAILF& G.F.C.I:—I G & S CARMCTaR Lac.#WSW BUX 215 This cm4dk eta must not be *bored in any momer; return-for the office. of ow.'Board.if:atmrrect. brspecion raw iw ' �y heir:oocde ntoals. rzr;i,t:e 1,4,1F[rCT10N REP0rtT DATE COMMENTS it b FOUNDATION (2ND) ------------------------- --------;r------,--------------_____-________-__=__________--_-__- II II ROUGII FRAME tx -----�;— — (Jj PLUMBING II _s _ I H O INSULATION PER N. T . STATE ENER", Ij i -------------------------I --- i — ---------------- ---- - =-—_ _-- -- -------------- i II II FINAT, - �� II — > ADDITIONAL. COMMENTS: -----------------------------------------=------------------------------------------------ rn Na �rl APPEALS BOARD MEMBERS O��ufFO(/-CD Southold'Ibwn Hall �� Gy Gerard P. Goehringer, Chairman o 53095 Main Road Serge Doyen, Jr. co P.O. Box 1179 James Dinizio, Jr. O Southold, New York 11971 Robert A. Villa y?��l ��0� Fax (516)765-1823 Lydia A. Tortora Telephone(516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD AUG 2 1 ACTION OF THE BOARD OF APPEALS DATE OF ACTION: August 9, 1995 APPL. #4324. APPLICANT: RICHARD MAUTNER. LOCATION OF PROPERTY: 2055 Bayshore Road, Greenport. NY. 1000-53-4-12. BASIS OF APPEAL: Notice of Disapproval issued by the Building Inspector on July 18, 1995. "Proposed construction is less than 75 ft. from bulkhead . and will have insufficient side yard setback. . . ." PROVISIONS APPEALED FROM: Art. IIIA, Section 100-30A.3 and Article XXIV, Section 100-244B. RELIEF REQUESTED: Variance for addition for open deck with reduction in south (south/east) side yard setback from present 7.5 feet to a requested 3.5 feet, and reduction in setback from bulkhead from present 55 feet at the northeasterly corner to a requested 35 feet at its closest point. MOTION MADE BY: James Dinizio, Jr. , Member SECONDED BY: Gerard P. Goehringer, Chairman ACTION/RESOLUTION ADOPTED: Denied 3-1/2 ft. reduction in sideyard, and Granted setback from bulkhead provided deck is not wider than the existing width of the . house and is not closer than 55 ft. . to the bulkhead at the northeasterly corner at its closest point. REASONS/FACTS: The setback requested is similar to those existing along the waterfront in this area. The relief requested will not produce an adverse effect or impact on the physical or environmental conditions of the neighborhood as an "open" and "unenclosed, unroofed" deck addition. Grading and drainage is not to be toward the waterway or bulkhead area and shall be property retained. VOTE OF THE BOARD: Ayes: Serge J. Doyen, Member James Dinizio, Jr. , Member Robert A. Villa, Member Lydia A. Tortora, Member Gerard P. Goehringer, Chairman-Member This resolution was unanimously adopted. i FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL Date . .,1.19. . . . . . . . . . . . . . . . . . .. 19 -:P .. To 1?0,4v ." CG� GG � -6- 71 PLEASE TAKE NOTICE that your appl•cation dated . .;j /. . . . . . . . . . . . . . . . .. 19 s � tel: . . . . . . for permit to �. at Location of Property . . . House NO.. Street • •Hamlet County Tax Map No. 1000 Section �. . . . . . Block . . . . . . . . . . . Lot . . . . . . . Subdivision . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . . . Lot No. . . . . . . . . . . . . . . . . . is returned herewith and disapproved on the following ®a pp g grounds .��.�i.�. . .�=•4%4��. �k���4-��-. r � s / . . . ?. . . c . . . . . . . . . . G. . . . . . . . . . . . . . . . . 000, 01 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4z- �: = . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • • • • Buiil king Inspector • . . . . . . . RV 1/80 77 20 �+ t t tw YS. �e►} IE Lu S N 3 =. tU4gr'+o e t ,ram is s4rma eAe _1 La 1T 35 o or �atio-,°l�aH pies e/ ),Cl* d..1-4bMACHU-41 theI..d Urissa tI i em�ss,Yey yyme z } l c a�rr ra iyn%oaliao14 a�o'r Gi �nlyta ees;� pJ eons y t t , MAR il�f. 411 . . PROPERTY p�epathelters0, he lend hem �d°`r hI � shaft O F Nt l�Q V E Y E v L t', essl9?�loa l mejrla "ro ns",�"bi' � � } `P �o�GK Vq� L� �- P y j — rosy~Guaarrot+h�hey y� co nQJ /'" f f \ �i TOMZ Ma/�e?e , 6rL6 A: j S 25 A','--.I , t^r r^ I LAND 5 _r - IZ g4A: f. t . 2VE Y`��4 DULY 27 IN TU� + -- �- PECOf`tlC SAY ESTATFS '1(.E6 .i lei .TNT S°JF� _ -• . �.. - -__. v coo.ge.1 s OF�►c .AS.4. . r Q 4 I�.3, 1q. �ti ? �RFE°�3t` 1. 4. c '���1 .4•FP`-.a e_>'`t''.',+ .;i�"t�'r �wk?�... �.�Y^-..a �.:N� _`5� _ �. ,:.ti..:.?. ti? ... :P:_ .r. _. ~. r./ t '' `Ty. - -.f :i•` .~ Albert J. Kru ski,President Town Hall John Holzapfel,, Vice President �� � G�� 53095 Main Road .. s , < P.O. Box 1179 t3 nt3 r William G. Albertson Martin H. Carrell O ,_» Southold,New York 11971 Peter Wenczel �'�Ip� �.�®� Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 30, 1995 Richard Mautner 2055 Bayshore Rd. Greenport, NY 11944 Re: SCTM #53-4-12 p Dear Mr. Mautner, The following action was taken by the Board of Trustees at their regular meeting of June 29, 1995: RESOLVED that the Southold Town Board of Trustees approve an Amendment to Permit #4193 to construct a 20 ' X 35 ' deck to an existing house as per revised survey dated May 15, 1995. If you have any questions, please call our office. Very truly yours, o � Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. CAC Bldg. Dept. New York State Department of Environmental Conservation �P�tN oAr�s Building 40 -SUNY, Stony Brook, New York 11190-2356 Phone (516) 444-0365 z Fax # (516) 444-0373 1 2 �Q441 'VTX-t"V �~� Michael D. Zagata Commissioner July 10, 1995 Mr. Richard W. Mautner 60 Lenox Avenue Lynbrook, New York 11563 RE: 1-4738-00675/00004-0 Dear Mr. Mautner: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. imiltP truly yours, ES T. HAMILTON Administrator CTH/ls enclosure File NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-00675/00004-0 July 6, 1995 FACILITY/PROGRAM NUMBER(S) P E flIV1I T EXPIRATION DATE(S) Under the Environmental July 6, 1999 Conservation Law I TYPE OF PERMIT 0 New 0 Renewal 0 Modification 0 Permit to Construct 0 Permit to Operate 0 Article 15, Title 5: Protection ❑ 6NYCRR 608: Water Quality 0 Article 27, Title 7; 6NYCRR 360: of Waters Certification Solid Waste Management 0 Article 15, Title 15: Water 0 Article 17, Titles 7, 8: SPDES 0 Article 27, Title 9; 6NYCRR 373: Supply Hazardous Waste Management ❑ Article 19: Air Pollution 0 Article 15, Title 15: Water Control 0 Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined Land 0 Article 15, Title 15: Long Reclamation 0 Article 36: Floodplain Island Wells Management 0 Article 24: Freshwater Wetlands 0 Article 15, Title 27: Wild, 0 Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers I Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control 0 Other: PERMIT ISSUED TO TELEPHONE NUMBER e% W (212) 599-4700 Richard W. Mautner H (516) 599-2026 ADDRESS OF PERMITTEE 60 Lenox Avenue Lynbrook, New York 11563 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Linda Bertani, 1380 Oakwood Drive, Southold, New York 11971 (516) 765-1594 NAME AND ADDRESS OF PROJECT/FACILITY LOCATION OF PROJECT/FACILITY 2055 Bayshore Road, Greenport, New York 11944 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Pipes Cove DESMIPTIW (F AJrH RIZ® X7IVITY Construct a 201 x 351 deck addition to existing single family dwelling. All work shall be in accordance with NYSDEC approved plans. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS P.t" �V�S Bldg. 40, SUNY, Room 219, Stony Brook, NY 11790-2356 Cher4b AUTHORIZED SIGNATURE DATE July 7, 1995 Page 1 of 4 GMEPAL WDITICNS Inspections 1 . The permitted site or facility, Including relevant records,' . Is subject to in- spection at reasonable hours and intervals by an authorized representative of the Department of Enviromiental Conservation (the Department) to determine Wiether the permittee is ccnplying with this permit and the ECL. Such represen- tative rray order the vork suspended pursuant to ECL 71-0301 and SAPA 401 (3) . copy of this permit, including all referenced maps, dravings and special conditions, mist be available for inspection by the Department at .all tirres at the project site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. (Pe rmi t Changes and Plenam l s 2. The Department reserves the right to modify, suspend or revoke this permit Men: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regula- tions is found; b) the permit vies obtained by misrepresentation or failure to .disclose relevant facts; c) new material information is discovered; or d) envirorr ental conditions, relevant technology, or applicable I&V or regulation have rraterialIy changed since the permit v%es issued. Y 3. The permittee rrust submit a separate written application to the Department for reneAel , modification or transfer of this permit. Such application mist include any fours, fees or supplerental information the Department requires. Any renensl , modification or transfer granted by the Department rrust be in writing. 4. The permittee rrust submit a renenel application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination SVsten (EFDES) , Hazardous Vlhste Nbnagemnt Facilities (I'IT F) , major Air Po I I ut i on Control (APC) and Solid Vlbste Nbnagenent Facilities (S%fl; and b) 30 days before expiration of all other permit types. 5: Lhless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination perviously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. Other Legal Cbligations of Prermittee 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all darages, direct or indirect, of v%hatever nature and by Wxrrever suffered, arising out of the project described in this permit and has agreed to indemify and save harmless the State from suits, actions, danages and costs of every name and description resulting frcm this project. 7. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted v%ork nor does it authorize the irrpa i anent of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 8. The permittee is responsible for obtaining any other permits, approvals, lands, easerEnts and rights-of-my that Tray be required for this project. Page 2of 4 95-20-6a(7192)-25c Tidal Wetlands ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34 and 6 NYCRR Part 608 ( ) 9. That if future operations by the State of New York require an al- other environmentally deleterious materials associated' with the teration in the position of the structure or work herein authorized,or project. if, in the opinion of the Department of Environmental Conservation 13. Any material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly,without leaving large refuse piles,ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State,the owner may be ordered by the Department to a waterway. remove or alter the structural work,obstructions,or hazards caused 14. There shall be iz unreasonable interference with navigation by the work thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other herein authorized. modification of the watercourse hereby authorized shall not be com- 15.`If upon the expiration or revocation of this permit,the project hereby pleted, the owners, shall, without expense to the State, and to such authorized has not been completed,the applicant shall,without expense extent and in such time and manner as the Department of Environmental to the State,and to such extent and in such time and manner as the Conservation may require,remove all or any portion of the uncompleted Department of Environmental Conservation may require,remove all or structure or fill and restore to its former condition the navigable any portion of the uncompleted structure or fill and restore the site and flood capacity of the watercourse.No claim shall be made against to its former condition. No claim shall be made against the State of the State of New York on account of any such removal or alteration. New York on account of any such removal or alteration. 10. That the State of New York shall in'no case be liable for any damage 16. If granted under 6 NYCRR Part 608,the NYS Department of Environ- or injury to the structure or work herein authorized which may be caused mental Conservation hereby certifies that the subject project will not by or result from future operations undertaken by the State for the contravene effluent limitations or other limitations or standards under conservation or improvement of navigation,or for other purposes,and Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 no claim or right to compensation shall accrue from any such damage. (PL 95-217)provided that all of the conditions listed herein are met. 11. Granting of this permit does not relieve the applicant of the responsi- 17. All activities authorized by this permit must be in strict conformance It bility of obtaining any other permission, consent or approval from with the approved plans submitted by the applicant or his agent as part the U.S.Army Corps of Engineers, U.S.Coast Guard, New York State of the permit application. Office of General Services or local government which may be required. Roderick Ya!n Tuyl, 12. All necessary precautions shall be taken to preclude contamination Such approved plans were prepared by of any wetland or waterway by suspended solids, sediments, fuels, last amended date on .Tune 20, 1995 solvents, lubricants,epoxy coatings,paints,concrete,leachate or any SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. 2. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area' for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. 3. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. 4. The storage of construction equipment and materials shall be confined to within the project work site and landward of bulkhead. Supplementary Special Conditions A thru F attached.. DEC PERMIT NUMBER 1-4738-00675/00004-0 PROGRAM/FACILITY NUMBER 3 of 4 Page SUPPLEMENTARY SPECIJkL CONDITIONS The following conditions apply to all Tidal Wetlands; Freshwater Wetlands; Coastal Erosion Management;. and Wild, Scenic, and Recreational Rivers Permits: A. A copy of this permit, including all conditions and approved plans, shall be available at the project site whenever authorized work is in progress. The permit sign enclosed with the permit shall be protected from the weather and posted in a conspicuous location at the work site until all authorized work has been completed. B. The permittee shall require that any contractor, project engineer, or other person responsible for the overall supervision of this project reads, understands, and complies with this permit and all its general, special, and supplementary special conditions. Any failure to comply precisely with all of the terms and. conditions of this permit, unless authorized in writing, shall be treated as a violation of the Environmental Conservation Law. If any of the permit � conditions are unclear, the permittee shall contact the Division of Regulatory Affairs at the address on page one or telephone (516) 444-0365. C. If project design modifications become necessary after permit issuance, the permittee shall submit the appropriate plan changes for approval by the Regional Permit Administrator prior to undertaking any such modifications. The permittee is advised that substantial modification may require submission of a new application for permit. D. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of the permitted work, the bottom portion of that form shall also be signed and returned, along with photographs of the completed work and, if required, a survey. E. For projects involving activities to be undertaken in phases over a period of more than one year, the permittee shall notify the Regional Permit Administrator in writing at least 48 hours prior to recommencing work in subsequent years. F. The granting of this permit does not relieve the permittee of the responsibility of obtaining a grant, easement, or other necessary approval from the Division of Land Utilization, Office of General Services, Tower Building, Empire State Plaza, Albany, NY 12242 (516) 474-2195, which may be required for any encroachment upon State-owned lands underwater. DEC Permit No. 1-4738-00675/0004-0 Page 4 of 4 9520.1 (8r87)-9d New York State Department of Environmental Conservation' NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below.. Please refer to the permit number shown when contacting the DEC. Regional Permit Administrator Permit Number �� ® ®® ROBERT A. GREENE Expiration Date NOTE: This notice is NOT a permit ■ ■ St.Charles �I T M A 1 HOSPITAL & REHABILITATION CENTER %. 6 2 1 C A T -1928 11 /18/44 V, 200 BELLE TERRE ROAD,PORT JEFFERSON,N.Y.1 1 777 9 5 73 1954 50 I S;1 L T 7-M -1 N LOIS is .D 60 LENOX AVE ADAPTIVE EQUIPMENT LYNFIR0.1K . Nly RECOMMENDATIONS FOR POST-DISCHARGE USE Please order only those specific items indicated below. I. BATHROOM EQUIPMENT Suggested Manufacturer/Model 1. Commode " e� Y 2. Toilet Safety Frame 3. Raised Toilet Seat 4-1-R I raj kc yr e - 4. Transfer Tub Bench C1 5. Shower Chair . H-OA UILL I'Li fbC LU F.I. 1 'r Yl I 2 LEI -15 FIFik'( �6. Grab Bars 44 b �1) k 0 VE e 7. Shower Hose rkirl mo 8. Other 1\1 n rl h 11. BEDROOM EQUIPMENT 1 Hospital Bed: Manual Electric 2: Trapeze Y 3. Bed Rails 4. Other 111. WALKING DEVICES - Issued via P.T., unless noted here 1. Fu k0mg ctl"S �nylce Lue. 0,v&, IV. WHEELCHAIR&ACCESSORIES 1.Type: 2. Legrests. 4. Accessories: Standard Footrests* Cushion Hemi-Height Seatbelt Tall 3.Armrests. Hemi Lap Tray Recli.ner Full Length Brake Extension Lightweight Desk Antitippers Wide Removable Other Narrow Other V. SELF HELP DEVICES 1. Reacher Sock Aide 3. Extended Shoe Horn 1/2. 4. Dressing Stick 5. Long Handled Bath Brush 6. Shoe Laces 7. Feeding Equipment 8. Transfer Belt 9. Other L Therapist's Name Date ' Department Phone#474-&59 iN,-\ Physician's Signature Date - •W\ 738:07 6/93 F WHITE-CHART CANARY-PT/FAMILY PINK-EQUIP/CLINIC ADAPTIVE EQUIPMENT RECOMMENDATIONS FOR POST-DISCHARGE USE v 1. -0-'%1 IL-- 1 and Rehabilitation Center Port Jefferson, New York INSTRUCTIONS TO PATIENT/OTHER ACTIVITY . Ct �. . TREATMENT : MEDI TIONS \ aSoa c--` .. � DIET : c�uv`ia � r. �� SW,� ti n '\) �� �`c,m \ `I* EQUIPMENT/APPLIANCES NEEDED : TEACHING PAMPHLET : FOLLOW-UP APPOINTMENT : Home Visit: Date Phone No. To Call M.D. Visit: Date hip �� h Phone No. To Call l el�'� �Le�►� C��. c 7�c qs I have received end understand the above: R. Signature & Date Patient's/Other Signature & Date Witness, if other than R. N. above S501742 Rev. 8/92 PATIENT COPY v APPEALS BOARD MEMBERS �o`OSUFFa��co G� Southold Town Hall Gerard P. Goehringer,Chairman o= 53095 Main Road Serge Doyen, Jr. y z P.O. Box 1179 James Dinizio,Jr. O Southold, New York 11971 Robert A. Villa 4 Fax(516)765-1823 Lydia A.Tortora �! �a Telephone(516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD August 17, 1995 John Bertani Builder, Inc. 1380 Oakwood Drive AUG 18 Southold, NY 11971 i fi r.:F !€aJ"+h O I D Re: Appl. No. 4324 - Mautner Variance Determination'`_---==- Dear John and Linda: Please find attached a copy of the Board's findings and determination rendered at our August 9, 1995 Regular Meeting with reference to the above variance application. As indicated in the written determination, the Board of Appeals denied the sideyard reduction and therefore you will need to prepare a new drawing for the alternative granted, with reduction in size, for your building-permit application record. All projects which are located within 500 feet of a waterway or State or County road are required by the County Administrative Code to be reviewed by the Suffolk County Department of Planning. You may be contacted by their agency over the next few days. Very truly yours, Linda Kowalski Enclosure Copy of Decision to: Building Inspector's Office r APPEALS BOARD MEMBERS O��$11fF0[�CO �� Gy Southold Town Hall Gerard R Goehringer, Chairman o= 53095 Main Road Serge Doyen,Jr. y a P.O. Box 1179 James Dinizio,Jr. O Southold,New York 11971 Robert A. Villa y?J O� Fax(516) 765-1823 Lydia A.Tortora �! �a Telephone(516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD ACTION OF THE BOARD OF APPEALSi ,9g� DATE OF ACTION: August 9, 1995 APPL. #4324. APPLICANT: RICHARD MAUTNER. LOCATION OF PROPERTY: 2055 Bayshore Road, Green port. NY. 1000-53-4-12. BASIS OF APPEAL: Notice of Disapproval issued by the Building Inspector on July 18, 1995. "Proposed construction is less than 75 ft. from bulkhead . and will have insufficient side yard setback. . .." PROVISIONS. APPEALED FROM: Art. IIIA, Section 100-30A.3 and Article, XXIV, Section 100-244B. RELIEF REQUESTED: Variance for addition for open deck with reduction in south (south/east) side yard setback from present 7.5 feet to a requested 3.5 feet, and reduction in setback from bulkhead from present 55 feet at the northeasterly corner to a requested 35 feet at its closest point. MOTION MADE BY: James Dinizio, Jr., Member SECONDED BY: Gerard P. Goehringer, Chairman ACTION/RESOLUTION ADOPTED: Denied 3-1/2 ft. reduction in sideyard, and Granted setback from bulkhead provided deck is not wider than the existing width of the house and is not closer than 55 ft. to the bulkhead at the northeasterly corner at its closest point. .REASONS/FACTS: The setback requested is similar to those existing along the waterfront in this area. The relief requested will not produce an adverse effect or impact on the physical or environmental conditions of the neighborhood as an "open" and "unenclosed, unroofed" deck addition. Grading and drainage is not to be toward the waterway or bulkhead area and shall be property retained. VOTE OF THE BOARD: Ayes: Serge J. Doyen, Member James Dinizio, Jr., Member Robert A. Villa, Member Lydia A. Tortora, Member Gerard P. Goehringer, Chairman-Member This resolution was-unanimously adopted. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL. RECEIPTS NAME ADDRESS STATE OF NEW YORK ) ss.: COUNTY OFSUFFOLK) residing at being duly sworn, deposes and says that on the day of 119 , deponent mailed a true copy of the Notice set forth on the re- verse side hereof, directed to each of the above-named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the addresses of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Of- fice at ; that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this day of 119 Notary Public ( This side does not have to, be completed on form transmitted to adjoining property owners . ) JUL 2 0 1995 BOARD OF APPEALS TOWN OF SOUTHOLD : In the Matter or the Petition of, , (x a n NOTICE to the Board of Appeals of the Town �f Southold TO ADJACENT TO: 5���-{�v��l, ��,n �l(I�(. }��t- PROPERTY OWNER U YOU ARE HEREBY GIVEN NOTICE: 1. That it is he intention of the undersigned to petition the Board of Appeals of the Town of Southold to request a Q avian ) (Special Exception) (Special Permit) (Other) (circle choice] 1. 2. That the property whi h is the subject of the Petition is located adjacent to your property and is des- cribed as follows: rkathpazu. rot E1 (14 — 3. That the property which is the subject of such Petition is located in the following zoning district: -I' That by such Petition, the undersigned will request the following relief: w7e-r n�sS�e� l 0',V 9y ` d 5. That the provisions of the Southold Town Zoning Code applicable to the reli f sought by the under- signed are Article Section IOU.W IVA A_1_1l& � kA:L 100-3 A l [ ] Section 280-A, New York Town Law for approval of access over right(s)-of-way. 6. That within five days from the date hereof, a written Petition requesting the relief specified above will be filed in the Southold Town Clerk's Office at Main Road Southold, New York and you may then and there examine the same during regular office hours. (516) 7d5-1809. 7. That before the relief sought may be granted, a public hearing must be held on the matter by the Board of Appeals; that a notice of such hearing must be published at least five days prior to the date of such hearing in the Suffolk Times and in the Long Island Traveler-Mattituck Watchman, newspapers published in the Town of Southold and designated for the publication of such notices; that you or your representative have the right toajpp'ear.and be heard at such hearing. Dated v if7, tqOr J� der- Petitioner Owners ' Names :-6 • Post-Of ice ddress Tel . No . 7 F 11-1 [Copy of sketch or plan showing proposal to be attached for convenience purposes . ] V Lar 3-3 a tit:4!'47`26 E. p ;c 6 � r to I - r^ Z 5.45`47�ZC`i w. O '+ . 3 N Cy cf-4 I I Q i l LOT 35 PZE OF N .. 5�o�Rick`F� f J. s C 14 ON)AcHUiZ 1 cz efferetlon orpdditlorl n m 2 i to this survey is a violation of ..?� *d n 7203 of the New Yodc State 1/I/�P 1'l C� P(�O{a E R`��/ � F�dueation law 1. !/-\ lJ r ( f" c ` S5 �o` 0 ` . ies of this survey map not aring p fsinkedseal 5t RVI/ YED FOPS / i th land surveys 4. i em seal shall not b?considered f to be a valid We copy P t ( µ Guarantees indicated hereon shall run i.CPA Fd „ i only to the person for whom the survey is prepared end on his behalf to the 1 title an compy,governmental agency and i, f lending iestitu.on listsd hMon and t�; ' t to the assignees of the not transferable r g insra !'�.iC CJ,' � t4Jl l'1 UE. lotion.Guarantees are not trees ereb,e 1^3 lf( r/;[ r t.t to additional institutions or subsequent -�OW � �F 5�{ +-{��� C! �`� SCALE � =k ram }1: ;8?S S.F.+ ; I MAY .15. L1995 tFt 'tu Awi�iD€D tt�P ,, T �..:.� l'._.. PECO�1tC RAY ESTATES �'!t� -- - .�-�.V..�~� .�:�___.__- : fC+ .Pont ��t(7VE C}T NPO ``T`;►rt-Y' 2;5UFF C- .TRX Map C Tfi� i }• 3 t?. APPEALS BOARD MEMBERS O��SUFFO(�c�G Southold Town Hal( Gerard P. Goehringer, Chairman c� ti� 53095 Main Road Serge Doyen, Jr. V' P.O. Box 1179 James Dirdzio, Jr. O ® Southold, New York 11971 Robert A. Villa y�j®� �a0� Fax(516)765-1823 Lydia A.Tortora Telephone(516) 765-1809 BOARD OF APPEALS - TOWN OF SOUTHOLD AUG 2119% ACTION OF THE BOARD OF APPEALS DATE OF ACTION: August 9, 1995 APPL. #4324. _.,�__-'_`f' APPLICANT: RICHARD MAUTNER. LOCATION OF PROPERTY: 2055 Bayshore Road, Greenport. NY. 1000-53-4-12. BASIS OF APPEAL: Notice of Disapproval issued by the Building Inspector on July 18, 1995. "Proposed construction is less than 75 ft. from bulkhead . and will have insufficient side yard setback. . . ." PROVISIONS. APPEALED FROM: Art. IIIA, Section 100-30A.3 and Article XXIV, Section 100-244B. RELIEF REQUESTED: Variance for addition for open deck with reduction in south (south/east) side yard setback from present 7.5 feet to a requested 3.5 feet, and reduction in setback from bulkhead from present 55 feet at the northeasterly corner to a requested 35 feet at its closest point. MOTION MADE BY: James Dinizio, Jr. , Member SECONDED BY: Gerard P. Goehringer, Chairman ACTION/RESOLUTION ADOPTED: Denied 3-1/2 ft. reduction in sideyard, and Granted setback from bulkhead provided deck is not wider than the existing width of the house and is not closer than 55 ft. to the bulkhead at the northeasterly corner at its closest point. REASONS/FACTS: The setback requested is similar to those existing along the waterfront in this area. The relief requested will not produce an adverse effect or impact on the physical or environmental conditions of the neighborhood as an "open" and "unenclosed, unroofed" deck addition. Grading,and drainage is not to be toward the waterway or bulkhead area and shall be property retained. VOTE OF THE BOARD: Ayes: Serge J. Doyen, Member James Dinizio, Jr., Member Robert A. Villa, Member Lydia A. Tortora, Member Gerard P. Goehringer, Chairman-Member This resolution was unanimously adopted. APPEALS BOARD MEMBERS O 4,SUFF0i/r Gy Southold Town Hall Gerard P. Goehringer, Chairman c < 53095 Main Road Serge Doyen,Jr. co z P.O. Box 1179 James Dinizio,Jr. O ® Southold,New York 11971 Robert A. Villa 41, O Fax(516)765-1823 Lydia A.Tortora Ol �a Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD ACTION OF THE BOARD OF APPEALS AUG $ 0DATE OF ACTION: August 9, 1995 APPL. #4324. APPLICANT: RICHARD MAUTNER. - LOCATION OF PROPERTY: 2055 Bayshore Road, Greenport. NY. 1000-53-4-12 BASIS OF APPEAL: Notice of Disapproval issued by the Building Inspector on July 18, 1995. "Proposed construction is less than 75 ft. from bulkhead and will have insufficient side yard setback.. . ." PROVISIONS. APPEALED FROM: Art. IIIA, Section 100-30A.3 and Article XXIV, Section 100-244B. RELIEF REQUESTED: Variance for addition . for open deck with reduction in south (south/east) side yard setback from present 7.5 feet to a requested 3.5 feet, and reduction in setback from bulkhead from present 55 feet at the northeasterly corner to a requested 35 feet at its closest point. MOTION MADE BY: James Dinizio, Jr., Member SECONDED BY: Gerard P. Goehringer, Chairman ACTION/RESOLUTION ADOPTED: Denied 3-1/2 ft. reduction in sideyard, and Granted setback from bulkhead provided deck is not wider than the existing width of the house and is not closer than 35 ft. to the bulkhead at the northeasterly corner at its closest.point. REASONS/FACTS: The setback requested is similar to those existing along the waterfront in this area. The relief requested will not produce an adverse effect or impact on the physical or environmental conditions of the neighborhood as an "open" and "unenclosed, unroofed" deck addition. Grading and drainage is not to be toward the waterway or bulkhead area and shall be property retained. VOTE OF THE BOARD: Ayes: Serge J. Doyen, Member James Dinizio, Jr., Member Robert A. Villa, Member Lydia A. Tortora, Member Gerard P. Goehringer, Chairman-Member TYii d�.� �' B*P Led. THE, SOLiTi10LD TGW11 CLERK � ,� ) DATE Y1 "� W HOUR//'Ov ��GERARD P. GOEHRINGER, ' HA MAN 4 Town Cezlt, Town. cf 2J7(r� 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ ] FIREPLACE&CHIMNEY REMARKS: DATE � INSPECTOR FORM NO.. 9 30 'D OF HEALTH _ 4 � SETS Of/ PLANS TOWN OF SOUTHOLD SURVEY %� r_ . - - . . . . . . . . . . — - (BUILDING DEPARTMENT CIIEC -K4.:� . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM SOUTHOLE_� � SOUTHOLD, N.Y. 11971 �r -- _-- _- -_? TEL.: 765-1802 all"o CALL ._�J. _ ���- ��. . . . . _ fC. . Examined , 19�q MAIL TO : Approved ��3J . . . . ., 19/ Permit No. � � I` . . . . _ . . . . . . . . . . . . . Disapproved a/c � ``��''�— .� . . .. . . . _ . . . . . . . . . . . (Bu' di Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . . . . . . . . .. 19 . . . INSTRUCTIONS Z This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets��f plans,accurate plot plan to scale. Fee according to schedule. . IJ1 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 of property must be drawn on the diagram which is part of this appli- cation. tc. 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 issued 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 building for necessary inspections. .n . �,r lx�n!. u,�.ld�rr�c� . . . . . . . . . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee,. agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . . .e�j c� A. .00-f:��CCLP � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . . \�`1-�(1(I,( �- . w.'. . 1 .�. lU ll�`�r1e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If ap �Cam;c o.�narp�or.a tion�, signature of,duly authorized o fficer. . . . . . . . . . . . . . . . (Nend title of corporate officer) Builder's License No.. . . f .( . . !. . .:L . , . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. Other Trade's License No. 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �. . . . . . . . . . . . . . . . . . . . . . . � Yl.'JO.r . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . .J5.1. . . . . . . . . . Block . . . . . . . . . . . . . . Lot . . . .� J Subdivision .�� (57�4�. . ,� -k�. . . . . . . . . Filed Map No. 1!HV .°c. .1. . . . . . . . . Lpt . . 3.y. , . .. . . . , ,. . ., . . !` (tVame) 2. State existing use and occupancy'of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . .�� . .'C-. . . . . . . . . . . . . . . . . . . . . . , , , , . . . , , , , , 3. Nature of work`(check which a - pplicable): New Building . . . . . . . . . . Addition ��-�-. . . . Alteration Repair . . . . . . : ._. . :. : . Removal . , Demolition . . . . . . . . . . . . . . Other Work . . . . ... . . . . . . . . . . . . . . . . . . . . (Description) 4. Estimated Cost . . . . . . . . . . :'. . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. 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 type of use . . . . . 7. Dimensions of existing structures,if any: Front . . . . Rear Depth . . . . Height . . . . . . . . . . . .. . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of sam_ structure with alterations or additions: Front Rear . . Depth . . . . . . . . ... . . . . . . . . . . . . Height . Number of Stories . . . . . • . . . . . . . . 8. Dimensions of entire new construction: Front . . .3 . . Rear . .3.s� . Depth . • . Z P 1. . Height .. . . . . . . . Number of Stories . . , • • ' ' ' ' ' 9. Size of lot: Front . . . . . . .k[�/. . . . . . . . . . . . . Rear • . . . ." .9 r . . . . . . . . . . . . . . . . . . . . . . . i . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . ... . . . . . . . . . . . . . . Depth . . . ,3 . . . . . . . . . . . . . . . �me of Former Owner .11. Zone or.use district in which premises are situated • . . . • . • . . • . • • . . . ' ' ' ' ' ' ' ' ' ' ' ' ' 12. Does proposed construction violate any zoning law, ordinance or regulation: N0• . . . . . . . . . 13. Will lot be regraded h . Will excess fill be re oved fro }s . .y. 14. Name of Owner of premises jJ� d� �1 �1 '/. Yes .�9' •�`•`cu1P�a. �•�•1Gtl.S �L� : . Address ��? .l eV1c1�0, one o. Name of Architect .Address � � � � � • Name of Contractor .. .14 . n .�J,2;�;�G.ti; ' ' ' ' ' ' �J`P °�. . . . . . . . . . . . . . . . •�U. Address la&D 0G�.�.l u�c! �r o e o. 15. Is this property within 300 feet of a tidal wetland? Yes. .><. . . . No. . . . . . . . . *If. yes, Southold Town Trustees Permit may be required. 1 PLOT DIAGRAM 4� 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 whe'ther interior or corner lot. STATE OF NE�YO K, COUNTY F . . �; -�,l/L. S.S • • • . • • . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. II JJ Heis the . :. . . . . . . . . . . .V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 all 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 1 . . . . . . . . . ... . .. . . . . . . .day of. . . . . . . . . . . . .Votary Public, . . . . ; . • • ,�• , , County JOYCE M.WILKINS Notary Public,State of New York (Signature of a No.4952246,Suffolk Countyapplicant) Term Expires June I Z 19-9