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HomeMy WebLinkAbout22225-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ' CERTIFICATE OF OCCUPANCY No Z-23340 Date NOVEMBER 10, 1994 THIS CERTIFIES that the building ACCESSORY Location of Property 525 TUTHIL ROAD EXT. SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 6 Lot 15.17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 19, 1994 pursuant to which Building Permit No. 22225-Z dated AUGUST 1, 1994 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 SWIMMING POOL WITH DECK SURROUND & FENCE ENCLOSURE The certificate is issued to JUDITH SEIBERT (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-324487 - AUGUST 22, 1994 PLUMBERS CERTIFICATION DATED, N/A din 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 . 1...l............. 19.FK. ....................... . �'� 22225 Z Permission is hereby granted to; 77- [.J Y ................... .. .. .... ...... .............. ............. /,� ... ............ �a .. -7 ..� ,... �........... to .... ./r /,......;-ml . - .p4r ...... .., ? .................... 0.0...l.,........�!, G .�.Y...CQ......� f 7.. .� .�.M..pV .T....... ....................................... ........0..... � .. . ... .. .. �..........�:........... . .. .... �.�.P. ...... .!. ?`..... d � �.�n�+:�... .. . ems....---.................. at premises located at...... 5 .... .... ./..... ..............................I.................. County Tax Map No. 1000 Section ..... fir....... Block........ ............. Lot No. ..f..�c �.�7...... pursuant to application dated .................. /.�............ 19..?. ......... and approved by the Building Inspector. Fee$...���. ... `� > - Q 3 Lfga Cf Building Inspec 'r Rev. 6/30/80 Form No. 6 -•--- _ _. _ TOWN OF SOUTHOLD BUILDING TOWNDEPARTMENT !�l I! Nov - 9 1994 765-1802 li BLDG.DEPT. TOWN!OF SOUTHOLD APPLICATION FOR.CERTIFICATE OF OCCUPANCY A.. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: 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 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 showing all 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 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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date November. 7 , 1994 (Swimming Pool) ' " " " " " " " New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. .�25. . . . . . . . . . . .Tu.t�iIll„Rd;, Ex t;„ . . . . . . . . . . . . . .SQuthg1d House No. Street Hamlet . Onwer or Owners of Property. . .jllA � h. A•. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . 5.5 . . . . . . .Block. . . . . .Q6 . . . . . . . .Lot. . . 15...17. . . . . . . . . . . . . Subdivision. . Rigbpo.irit. M.44p1gs .5pp.•. .Z. . . . .Filed Map. . .4�1;. . . . .Lot. . . . . .L4 . . . . . . . . . . . . . . Permit NoZ222S.4 . . . . . . . . .Date Of Permit. .0MOA/9.4. . . . .Applicant. .UE A44T.,, JUDITH . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . C�,ec• Lf 8 N 9 �o-�a33V a �g�fF01,��0 y Town Hall,53095 Main Road ® P. O. Box 1179 CO2 ae Fax(516)765-1823 - Southold, New York 11971 �� Telephone(516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 31, 1994 '} Judith M. Seibert 525 Tuthill Road Ext. Southold, NY 11971 To Whom .This May Concern: We are unable to complete your Certificate of.. Occupancy because of the following reasons : xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XX The check is 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 # 22225-Z --------------- Please contact our office on this matter. Thank you fo cooperation. y r 'x SOUTHOLD TOWN BUILDING DEPT. ?'r✓�r s'�.r ai, r r`' -. c 2,, ' 4 T s.. : }-c 'r _...�e'. '27 ,{. r --" 3 yy4� tl J FO(Ir�oG . y< Town Hall,53095 Main Road y Z Fax(516)765-1823 P. O. Box 1179 �� • Telephone(516)765-1802 Southold, New York 11971 ijr 0! poi �a OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 31, 1994 Judith M. Seibert 525 Tuthill Road Ext. Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is 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 # 22225-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000719 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 . Date AUGUST 22,1994 ,Application No.on file 06295994/94 N 324487 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of SEI,BERT,JUDITH, 525 TURTHILL ROAD EXT. , SOUTHOLD, N.Y. in the following location; ® Basement ❑ Ist Fl. ❑ 2nd Ft. GAR/OUT Section Block Lot was examined on AUGUST 15,1994 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS AMT. WATTS SYSTEMS FEET SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER 1-0'4W 1.9 3W 3 03W 3,0'4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A.W G. NO.OF NEUTRALS A.W.G. EQUIP. PER 0OF CC.COND. OF HI-LEG OF NEUTRAL OTHER APPARATUS: SWIMMING POOL-1 TIME CLOCKS-AMP.40-1 G.F.C.I-1 -(SWIMMING POOL) This certificate covers compliance at the date of inspection only. Because of unusual -environments it is advisable to have frequent test/and or repairs p made by a qualified person. <<< Continued on Page 2 >>> GENERAL MANAGER Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER!. THE: ,NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 2 1000719 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 AUGUST 22,1994° ', Application No.on file 06295994/94 N 324487 Date' THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of SEIBERT,JUDITH, 525 TURTHILL ROAD EXT. , SbUTHOLD, N.Y. in the following location; ® Basement ❑ lst Ff. ❑ 2nd Fl. GAMUT .Section Block Lot ttws examined on AUGUST 15,1994 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL I H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER I,,ZW 1,0'3W 3 A'X 3W 3,0'4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A.W.G. NO.OF NEUTRALS A.W.G. EQUIP. PER A' OF CC.COND. OF HIAEG OF NEUTRAL OTHER APPARATUS: R.C. ELECTRIC CORP. LIC.#1610-E 112 ItEYLAND COURT BOMETA, NY, 11716 GENERAL MANAGER 11 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. pus-isox BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING FINAL REMARKS: /5k&- DATE--/O/V�WIN8PECT0 7W-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ �NAL REMARKS: 1� s / DATE Y'INSPEGTOR �I•L� 1�•-Ni••.-V• �V •�`� rl .••.y I •r ., .......���.•1..�--^�J7r � .. � �(;(-1 v .r:�7t�vyy` •a :1 Jn a I COMMENTS )UNDATIOY CGYi UIIDATION 9:,-• UGH FRAME �•:'�: �` •PLUI-IBIVG•� ca r SULATIOIJ PER N. Y. STATE ENERGY �� f CODE • o ._ •FINAL d ADDIT AL COMiTENTS : m .. • r,, • x _ 7 .t+G1+.�►i.�`.�"'-•�'_�1'��--.�?:+riaY--.r..•s�:�y..•d l�ti 3�•• •��l'4.r•.'r .. � � � �_. __ � _. } FEW C vp(:gv� Pe o� NEGpl*� 10 M N � 'a UD in v O N 6 � I � 1 r I � w "yT1 1 On f fn O 0 0 \A 5 s t. N 0 0 Nino-bA201E. �° 2�99 O 0. o C t,0® o 0 205 N t`o LP • � 7 7.0 9 UI O gyp. r*} I �� � Cj, a O O 5 P ,P+ t O• 1266� O �i►! 9 1994 • `'' ' BLDG.DEPT. f TOWN OF SO UTHOLD f �. SURVEY FOR !. r ftICHARb.�OGLIA Q-'JOStPAINE SCIACCA :'•'. LOT No .14,1fHIGHNOINT MEAbOWS,SECTION TWO" ' AT SOUTHOLD bAtE i DEC. 13, 1990 TOWN OF SOUTHOLD ;rc, ', .i SCALE] 1"t40' SUFFOLK COUNTY 1 NEW PORK T•'• NO.. i •00.0904 •UNAUINORIttb ALftRATIOM 001 AODiftOA TO TNII CERTIFIED TO, fuRvt+ e A VIOLATION or SECTION ttoA D►,t111 RICHAR NtW 7OR■STA1t EDUCAIION LAW JOSEP 9 A Ch,t OF COPIES THIS SuoVtt MOT AtARMG.TNt'LAND SVRV(79R'f INRt 0 SEAL 00 tMAOSIEO Itk SNALL•• D•B q�1 Nat A(COttl W01C TO tE A VALID TRUE COPY 8 DO PtgJ�N!( L K ■OU AR Ar T(Cf INOIU T(D M(R(oN ylALl 01,1100100 10 '�". HEALTH DEPARTMENT•DATA FCA+ APPFI0%^L TO CONSTRUC T tHt-to" FOR WINDOW THE aW. OVE1 If►RtRARtD � 0 , • AND ON HIS G(NALF TO tMt IITLt Ci71AFMIT,ibrtFw: '.I•. v N/AR[ST WATtA MAIN MI A ■SOUNC[t OF WATER.►IIIAlf—IUGLIC I MENTAL AOtMCI AND LENDING tNI1111)TION LtIT(0' yl' y IFKW/ CO TAW MAP OIfT,O-StC TION iS ALACR!LOT M jS•1 HEREON,AMC 10 TNt Afl1GNEtl DI.tMt LENDING r TTITM ARC HO OvCLLIIM■ WIITIIIN too►tt♦ O► 11AA FRO►tR1V WSIITUTEOM GUAVAN ttt ANt NOT fll/►1 lRAGL� OTHtR THAN THOlt IHOWN HEREON TO ADOITI00 L M1SII�UTf01f bN fUGft OV AT r;:• N iME'wATtR SU►/L+MO 11VIA41t DISAOIAL t1STEM/ON TNIG AOIDEHC( OWNERS ,L WILL CIf1IORN TO THE AtANom"0/ 1Mt fV//oLR COUNTT D(RARIMtot r D1 STA TONS IfIlUt Nt NteR FROM�NIOFtN FI UNEI O ,� TO E.If T,rA f fNUt lVRtt AAt FOR A SPECIFIC R Or wVALTN AC/TVICtA PURPOSE AMD ARE NOT 10/t USED t0 tITAGLION a� A15 AA�LICArI►' FRD►tR1t tints ON FOR THE ERt011011 a ►t"CEt (ANDI ' AfN+Rt tl TtL YOUNG ,W)"OUNG RRI ER HEAD,MAPIOER EWAYOR.KE FIOTE: A:STAKE PIPE ALDEN W.YDUNG,PAOFESSIONAL ENGINEER ' SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF AND LAND SURVEYOR N.Y.S.UCENSE NO.12S45 SUFFOLK COUNTY ON MAR,19,1990 AS FILE NO.8911. HOWARO W.YOUNG, LAND SURVEYOR r N».LDu,rlo+a.1LL1.I,unle rAHHI1nA etl.r00ltlCrl sHo`.H NlAEON N.Y•S.LICENSE N0.1SS9� ' Nt I-C.-1/ItLO"ltW^TIDHI ANO OR DATA OATAJNED FROM OTHERS (,S NRANDIS A tONI INC. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL FOUTHOLD, N.Y. 11971 if it 9 1994 TEL.: 765-1802 am* edB D I x Received . . . . . . . . . . . ) 19 . . 91-1 Approved . . . . . . . . 19 . . Pen-nit NooA.zng?;�kl Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . .. . . . . . . ... . . . . . . . . . . . . . . .. . . . . (Building Spec or P CATION FOR BUILDING PERMIT Date . . . . . . . . . . . . . . . . . .. 19 . . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 3 sets of plans,accurate plot plan to scale. 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 giving 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 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, din c e, housing code, and.regulations, and to .,, u"' . I I :.,v A., admit authorized inspectors on premises and in building for necessary �-�-�e -,t i og n s 0 d f Sp- T S ture of applicant, nameifcorporation) )�z /7 (Mailing addWres of applicant) e, a9b'n ti!;'-arc itelc enginee generl��4(3 e State whether applicant owner lesse, r a e eqe&ri�ia ph�U builder. . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. H. 1 0 -c;S,.. . . . . Plumber's mber'&License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. M .—.6 . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . .. . . . . . . . . . . . J . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . Block . . . . . . . . . . . Lot . . .L Y. . . . . . . . . . . . .. . . Subdivisionfic �C? C.. . . . . yf Filed Map No. . . . . . . . Lot Name e)'� 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work p} O (Desc 'ptio lB_ a 4. Estimated Cost . . d.0�!-! .�. . . . . . . . . . . . . . . . . . . . . . . Fee . . . . (1 �1 . . . l.G t kto 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 and extent of'each type of use . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front��rr��0(�c. . . . . Rear .jt o .. . . . . . Depth p�� ��. �. . . . . . . Height . . . . . . . . . . . . . . . Number ofStories CSC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . ... . . . . . . . Height . . . . . . . . . . . Number of Stories . . . . . . . . . . . 9. Size of lot: Front . . . .�. 7. . . . . . . . . . . . . . Rear . . .10.,1 n. .$ .. . . . . . . Depth . �. . . . . . . . . 10. Date of Purchase . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate.any zoning law, ordinance or re-Ulation: . . �.Q. . . . . . . . . . . . .: :. . ... .-. .. . . . 13. Will lot be regraded .ro C). _ . Will excess ill a removed }om premises: Yes No. 14. Name of Owner of premises /k . Address r �X . Phone No. .°�6 .:�lD.�—`" Name of Architect �., - Address `�`� hone No. Name of Contractor (�Q/1J)1.4�1►?c �Q -�. Address fit` rIGG one No. 9 .Q1�. U _ 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. "'IRA MEDIATE! Y" . ENCLOSE POOL TO CODE UPON COMPLETION APPROVED AS NOTED BEFORE 'WATER" DATE: ` B.P.# �' , FEE: BY: NOTIFY BUILDING DEPA ENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. 1:0UNDATION - TWO REQUIRED REQUIRED UNDERWRITERS CERTIFICATE POR POURED CONCRETE 2. -,:;?UGH - FR, :t,'t4,VC; & PLUMBING 3 !`•?SUL.ATION l � , 13AL - :a�� .E;,E :1C a I©f�! pfjUST Y ��' y t �9 COMPLETE FOR C.O. .+DE's;gTctgUrT?()Pd SHALL MEET 1 J 'V.�it�' l�,_l €f OF TI`gt N.V. �� gSTt� 6 70 & a R Y �M`a7 k Il;CX6..f'i S � '9•' E�9�P�i i f j W I3L` L z)r�. .clrt�d,"WL FtESPG'.z �!?L_r_ s t � fp'QgS$ a STATE OF NEW YORK, S.S COUNTY OF.. . . . . . . . . . . �J•C.�•G1•i•:I • • S'e•I• • • . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the . . . . Co.711`Q-.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 beforelm;e this --�- � ft. . . . . . . . . . . . . .day of. . . . . . . . . . . . .. 199q. Nota � ' • ' `�� • ry Public, County /A DONNA M.TAYLOR � otary'Public,State of Now York X ��• .!. r% . . . . No.4891784 . . . . . Qualified in Suffolk County (Signature of applicant) Commission Expires June 01. i; • l I Tpw"LDF• DEPT A UNDERWRITERS CERTIFICATE � REQUIRED0 Y UK U0E IS UNLAW M , L M -DIATELY WITHOUT CERTIFICATE c c� .I ENCLOSE POOL TO UPON COM LET ONDE OF OCCUPANCY , BEFORE "WATER 2�� �� � cc►�L�i� � r , i' l 7N r'c:c,-- 'Your Comolete Swimming Pod Locatlon" JOB - - - — - i - erm C bmfort Iffod + SHEET NO. nt' OF . - M' a• ��'��•�� ecr- cica V 7, CALCULATED BY DATE CHECKED BY ^ATE SCALE