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HomeMy WebLinkAbout21177-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22489 Date AUGUST 2, 1993 THIS CERTIFIES that the building NEW DWEIJING Location of Property 275 JOHNS ROAD MATTITUCK NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 122 Block 3 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 29, 1992 pursuant to which Building Permit No. 21177-Z dated JANUARY 6, 1993 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 ONE FAMILY DWELLING WITH GARAGE IN BASEMENT AS APPLIED FOR The certificate is issued to MAYNARD PALMER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-69-AUGUST 2, 1993 ELECTRICAL INSPECTION APP. NO.2377 DATED APRIL 26, 1993 PLUMBERS CERTIFICATION DATED APRIL 22, 1993 - MATTITUCK PLUMB & HEAT. *MAINTENANCE OF ACCESS TO LOT REQUIRED. diiii111999999YY7YY7 Inspector Rev. 1/81 FORK NO. S 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) N 21171 Z Date .../00 19.x' f I Permission is hereby granted to: . <7-....................................... 7/ -...~.......al..~....... to ar. 8.. tY ./el%~ . ......'.'?7............ of premises located at .~s~. ..y . . County Tax Map No. 1000 Section Block .......5Z.3 Lot No /-6 pursuant to application dated 19..949 and approved by the Building Inspector. p Agee Fee . .t.: ~S........................ u ng Inspector Rev. 6/30/80 . Form No. G TOWN OF SOUTHOLD ~y BUILDING DEPARTMENT .7~~ ' _7700 s=' TOWN HALL `t 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This appil&tion must be filled in by typewriter OR ink and submitted to the building inspector`-~wi~,t.h' the following: for new building or new use: 1. Final"aY°i'rvey 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 1the 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 - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date 48R.T.1..~1.,..1~9~ New Construction........... Old Or Pre-existing Building Location of Property.. 275 JOHNS RD. MATTITUCK House No. Street Hamlet Onwer or Owners of Property ~,AYNARD PALMER County Tax Map No 1000, Section ...!?~........Block 3........... Lot.,,16 Subdivision ....................................Filed Map............ Lot...................... Permit No...~1177-Z..... Date Of Permit..! /95......Applicant. R0N M. 0RIZZO BuILDER,INC. . . . . Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Z..._ Request for: Temporary Certificate........... Final Certicate...Fee Submitted: APP T INSPECTORS Victor Lessard ^'JFFB( Principal Building Inspector Curtis Horton SCOTT L. HARRIS, Supervisor Senior Building Inspector o < " Thomas Fisher Southold Town Hall P.O. Box 1179, 53095 Main Road Building Inspector Southold New York 11971 Gary Fish Building Inspector Fax (516) 765-1823 Vincent R. Wieczorek za Telephone (516) 765-1800 Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD APRIL 19, 1993 RON MORIZZO BUILDER, INC. P. 0. BOB 789 SOUTHOLD, NY 11971 RE: MAYNARD PALMER ' To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XXX An application for Certifica e of Occupancy is not on file. (Enclosed) ffi No Underwriters Certificate on file. The check is not on file.)$25.00 " %YSC No Health Department Approval on file.U-Ll No final inspection has been made. %lIX No Plumber Solder Certificate on file. e-k (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 21177-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. CC: MAYNARD PALMER cvFFO(q- TOwN TEL. 765-1802 o, Or SOUTIJOLD o E' c OFFICE OF BUILDING INSPECTOR u' yVs I~i R P.O. BOX 728 TOWN N SOUTHOLD,Y. 11971 1 .,t C E R T z F 1 C T T O N MAY m 7 iC ? 3 i Date Building Permit No. 21177-Z Owner MAYNARD PALMER (please print) Plumber (please print) U L O <-al I certify that the solder used in the water supply system contains less than 2/10 of It lead. (re) Sworn to before me this ;G )6 q- ~2R day of 110tar7 Public _ Notary lic -County Eplll F ald(SON W" Mk so d 110. 47D768Nwr Yak Tom 60 Feb. it 19W Y AUG - 21993 a -11 BLDG ' DEPT TOWN OF SOUYAOLD J C a N z O 44C (o m c n y c m w > 2 ? C a m m F+ m . I y E; rr s o v m 0 m a (D (D N (D d "L' v Fr m< > m y m w n p a m n r c ° trJ m 0 1 m m x y y 3 o m c ° a s f 3 ° o N y n m 4 a a (o N m T N O y0 01 > Z n 0 (n =3 (D ° d o o v m n 0 m w C H W m Z` m H ~ ~4 _ > a o ° N D C m H m }.i (o ~i 3 D 9 O m m y y W 7 1,, 1(\ 3 S1 txj y n y y M Q. G1 m ( o m 3 y W (x ; Q, D Ci y 3 J m N CD- En cn 0 ((c ( o = y t > 0~5 a H c- C+'J i c w g m H W Z m ~ CL h f n "1 N o` y r' x y Al c+ 0 Z/~ C (o N H r -u Ja N o' n. o w In .3, n Z .Oi O y C a p N y O IT 2 (O S 1 (D 0 m C ~i n l< M ° 9 N S c Dr_ 3 a 7' = O Z zz g m Z n y = ° m m I a 0• 10 D` c/) ( 0 8 O C _ CD --I C T n 3 -4 o V 3 0 mm w v ~p o. r V o H N ` 'r (o y = O = n m o u v mm q 0 D ::r I (n 0) C~D ° N y m y a M i-+ c l1( D Z g CL D y z J v WD M w m_' D D N .D (j ° n 3 Q N 0 ~ o}j 4 z > CL CL U (o 3 o n 3 T O e m < O ~t y m m > ril (n -n y y y (D /nJ C o N o} W c ° NJr"l~ ! 1 `r')6 f 1 eN~1FMl~iddf'~)dtl(~~p(~'1~~!~ ! l f 1 pf~lHipt~1 ~!'1~cN'('M lC7~cN'itlc'N~1tlJCX~Vy o` v v v v v v v v v v v v v v v v v v v v v v F1::L;7 ,--."5:..~.i.;:~ 119A•7g. it ~~'lM6~t`~"S y v 'OUIIDATION (1st) - OUNDATION (2nd) I W L o ?OUCH FRAME & 1 -PLUMBING s. 3~3 3 H -NSULATION PER N. Y. n H STATE ENERGY I CODE J r^ FI11AL ADDITIONAL COMMENTS:`. b ' H H • F~ O - 1 q CTJ -o 95-206 (10/90)-25r, NEW YORK STATE DEPARTMENT OF ENVIRONMFNTAL CONSFRVAT ION DEC PERMIT NUMBER LFFECT IV[ DAIS 1-4738-00391/00001-0 Feb. 6, 1992 FACII.HY/PROGRAM NUMBCRb) PERMIT EXPIRATION DATE Under the Environmental Conservation Law (ECL) Feb. 29, 1994 TYPE OF PERMIT (Check All Applicable Boxes) MNew ?Reeewal ?Modificatron ? Fermi to Construct ?Fermit to Operate r SPDES 17, Titles 7, 8: Article 27, Title 9; 6NYCRR 3 Protection of Title 5: Article Hazardous Waste Management Article 15, Title 15: Article i Article 34: Water Supply Air Pollution Control Coastal Erosion Management Article 15, Title 15: Article 23, Title 27: Article 36: Water Transport Mined Land Reclamation Floodplain Management Wells S Article Fr eArticles 1 Control Long Island Title Wetlands 6NYCRR 380: Radiation F Article 15, Title 27: Article 25: Other: Wild, Scenic and Recreational Tidal Wetlands Rivers Article 27, Title 7; 6NYCRR 360: 6NYCRR 608: Solid Waste Management Water Quality Certification PERMIT ISSUED TO TELEPHONE NUMBER Ma nard Palmer ADDRESS or P[RMmrt P.O.Box 332, Cutchogue, NY 11935 CONTACT PERSON FOR PERMITTED WORK FE LEPHONE NUMBER NAME AND ADDRESS Of PROJECT/FACILITY LOCATION OF PROJECT/FACILITY Johns Road Mattitu k COUNTY TOWN/CWX/XbLk%%k WATERCOURSE/WETLAND NO NYTM COORDINATES - Suffolk E - Na - DESCRIPTION Of AUTHORIZED ACTIVITY Construct sin le family dwelling, driveway and septic system. All work shall be in accordance with the attached NYSDEC approved plans. iNT' Ir a;, 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 Reverse Side) and any Special Conditions included as part of this permit. rucg;cllt: cs,~, _9 1 PERMIT ADMINISTRATOR ADDRESS $LU'$Ya9i6 A ^ 'I~• David DeRidder t5sonn;vL7zcn%"'«•At`'r'n',`T•.a~5~ ~ DATE AUTHORIZED SIGNATURE fie " 2/6/92 Page 1 of !I GENERAL CONDITIONS Inspections 1. The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). A copy of this permit, including;all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. Permit Changes and Renewals 2. The Department reserves the right to modify, suspend or revoke this permit when: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of I,the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. 3. The permittee must submit a separate written application to the Department for renewal, modifica- tion or transfer of this, permit. Such application must Include any forms, fees or supplemental infor- mation the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. 4. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Department, Issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, con- ditions or requirements contained in such order or determination. Other Legal Obligations of Permittee 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibili- ty for all damages, direct or indirect, of whatever nature and by whomever suffered, arising out of the project described',in this permit and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from 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 work nor does it authorize the impair- ment 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, easements and rights- of-way that may be required for this project. I Page 2 of _ FOMI 110. 11 TOWN OP SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, ICY DEVELOPMENT PERMIT No -265,5~ F Date Pel:rinsion io horeby grantod to: 2zz 67 at promises located at County Tax Mnp tlo. 1000 Section -1,22 Block I,ot purwiunt to application dated 1yJ`?/z 9 19 3, and approved by the Building Inspector, :.'.wilding Poz,ait Ho. 7 7 _'L 5uni;ng Inspectol. b/L'J 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ I ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ `--FINAL REMARKS: DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL REMARKS: 777- DATE INSPECTO 4L M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND INSULATION [ l FRAMING [ ] FINAL REMARKKSs i r ' DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: i DATE INSPECTOR t a Application Received Disapproval Issued Permit 5~ 195'3 19_ 19 l J~ FORM NO. 10 APPLICATION FOR DEVELOPMENT PERMIT IN THE TOWN OF SOUTHOLD ~L / 19~ 1. 'hype or Development Proposed: New Structure (including storage tanxs X Addition and/Or Alteration Flood Proof Below Base Flood Elevation_ Other (specify) 2. Elevation Data in relation to above mean sea level of: (a) Lowest floor elevation, including basement _~Z feet 0 inches (b) In a V Zone, bottom of lowest structural member _feet inches 3. FIRM--Flood Insurance Rate Map, Zone designations 4. Owner of Premises •;r~G~ie.,.~n.~/ ~~v., 5. Location of Property: House # Street H inlet County Tax Map No., Dist. 1000, Section /a 2 Block Lot(s) Subdivision _ Filed Map# Lot(s) 6. Permission to be granted: _ Owner as above New Owner Under Contract _ Lessee _ Contractor _ Phone # Name 1f not given above Mailing address 7. Approval from other(s) before Permit is issued: DEC _ /_5/7~~_pp39/~ oool Wetlands (Town Board) Health Services F~--SO -~o ZBA Building Permit 7 7 Planning Board J~ 8. I, -_~i7 N h(o R! Z Z(q the applicant, am the Owner Co-Owner I_, New Owner Under Contract Lessee , A ent _ g Contractor , and agree to comply with all applicable sections of the Code of the Town of Southold; County, and State and to admit authorized inspectors to premises 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 my knowledge and belief and that the work will be performed in the manner set forth in the application filed therewith. STATE OF NEW,YORK/) COUNTY OF !`T '1 jJ (ham SS Signature 1 S R TO THIS DAY OF 19 93 / Notary pub i c CLAIRE L GL.EW Applicant's mail ry Public, State of Now York N0.4879506 address and phone dualified in Suffolk County if not given algg"ission Expires December 8, 18 11/85 FORM NO. 10 TOWN OF SOUTHOLD BUILDING DEPARTMENT (516) 765-1802 P.O. Box 728 Town Hall Southold, N.Y. 11971 Main Road Southold,N.Y. APIPT.T('D.TTnN POD nFVPU.0PMPNT PFPM7T Instructions: The application to the Building Inspector includes (each in duplicate) 1. Form No. 10 filled out in ink or typewritten, 2. Sur- vey of premises with ielevations above mean sea level, 3. Drawings of pro- posed work. The application must give complete information to show that the proposed can comply to the Local Law No. 1-1980, chapter 46 of the Code of the Town of Southold known as "Flood Damage Prevention Law" of the Town of Southold. The applicant must submit approvals that any other agency requires. General Standards as !required in Section 46-17 of the law to minimize flood damage: A. Anchoring of structures, including tanks and mobile homes B. Use of construction material and methods C. Design and location of utilities D. Subdivision proposal with drainage, public utilities design and base flood elevations Specific Standards as, required in Section 46-18: A. Residential construction B. Non-residential construction C. Mobile homes The applicant must submit plans and specifications as well as any other information requested!,by the Building Inspector to substantiate the facts that the structure ha's or will have the lowest floor, including basement/ cellar, elevated above the base flood elevation or; if permitted by the Federal Regulation, that: 1. such structure is flood proofed in such manner that below the,base flood level the structure is water tight with walls substantially and impermeable to the passage of water, 2. that structural components!,are capable to resisting hydrostatic and hydrodynamic loads and effects of buoyancy, 3. applicant must submit certification by a registered professional engineer or architect that the standards set forth in Section 46-18B (1) (2) (3) of the Southold Code are satisfied. Coastal High Hazard,. area (V Zone) 46-19. Applicant shall submit plans, specifications including the required certifications and such other in- formation as the Building Inspector may require in that the provisions of 46-19 are complied with. Mobile homes are prohibited. The lowest portion of the structural members of the lowest floor cannot be lower than the base flood elevation with all space below open except breakaway walls. Sand Dunes. If sand dunes exist on the premises and the applicant pro- poses to alter same, plans and specification must be shown in detailed nature of any alteration submitted. Building Permit. A Building Permit is also required for any structure. Both Development and a Building Permit must be issued before any work can start in a specia~ flood hazard zone. A written disapproval or a permit must be issuedl,within ten (10) working days. During construction, the inspector shall be notified in time so he may make the required inspections. Upon completion, the required certification of the final elevations and work must be submitted before the approval to use or occupy can be approved. ` (Fill out the form on the back of this sheet) ti 11/85 u n .mil iii ':Y ` •l _ift.: `~a-' r.,-_,;s'.iC`e.~u~t.A..,R'a...,.:.i.+. inv.,, :^w~,... .-s:>:a:>:i;,et+!.3.tistin'i.~o`,:tJ~.':$.C~..id+.i~:tiv rnoy.ii:1~5 BOARD OF HEALTH FORM NO.1 3 SETS OF PLANS& ...,:SURVEY fem TOWN OF SOUTHOLD CHECK r/.... , , IJC BUILDING DEPARTMENT SEPTIC FORM 41e TOWN HALL Q SOUTHOLD,N.Y.11971 NOTIFY: Ro mO?tZ-"Z-6 TEL.: 765-1802 CALL °7(oJ-57 7 19 MAIL TO: Examine .I. . Approved 19~c Permit No.. ~17,7 Disapproved a/c (Bu din Spector) APPLICATION FOR BUILDING PERMIT Date ~o2q 15~• 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 c)r 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, building code, housinl- code, and regulations, and to admit authorized inspectors on prcz rises and in building for necessary 'nspections. (Signature of applicant, or name, if a corporation) C). Lk (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............F.!'~.2 Name of owner of premises ....ma ~a?(~ jm e yl . (as on the tax roll or latest deed) If applicant is a corporation, stature of duly authorized officer. u r L I mc and ti of corporate officer) Builder's License No. vng-.4........ . Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of land on which proposed work will be done; , ...........t~ hns......~.., ?'n 0.++,+Ii-.Qy . House Number " " " " Street. Hamlet County Tax Map No. 1000 Section . Block .4!3.... . Lot..r Subdivision , . Filed Nlap No. Lot ` (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: b ~ n a. Existing use and occupancy ` % 0.-°'s,T;, 3 b L0yW4 .kieGatyrl Intended u use and occupancy .Ln..~.~.... ~ , t ;t 'a ~N tr °r,.f9t! atf~ lakY;at+. le;1I f ,:,travrtt>catyysAtS 3. Nature of work (check which appl`cable): New Building X... Addition Alteration Repair RRmov4l Demolition ..........Swimming pool........... . Tennis Court .....,~.1... Accessory Building Fehce .......Other Work............ V'A 4. Estimated Cost .4.1.4 f~.U.... 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 Hei-lit Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth . i. Height Number of Stories . 8. Dimensions of entire new construction: Front Rear Depth . Height Number of Stories . 9. Size of lot: Front Rear Depth . 10. Date of Purchase Name of Former Owner 11. Zone or use district in which promises are situated 1'. Does proposed construction violate any zoning law, ordinance or regulation: • . 13. Will lot be regraded Will e ces fill Wil v rom remises: Yes No.. 14. Name of Owner of premises npy.~Y~ YAddres Name of Architect ' Address . . y~ n pp~ P no o.. _ NameofContractor rt~~4.... AddressC.Q.,60,00" ~ 15.1s this property located within 100 feet of a tidal wetland? *YES NO.... *If yes, Southold Town'iTrustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all (buildings, whether existing or proposed, and. indicate all set-back dimensions froni property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. i II , II i STATE OF NE1 RK S.S COUNTY F , , , , , ,(,~,~r4,~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He isthc .............1 n7,Y.' ~ Y (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully 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 se*Ii,..n pplication file d therewith. Sworn to before me tis ..day of 19 Notary Publi . County No" Public, Stem (New Yodt No.48796 ~ Que11HeA In SuLmb;w I9~..1 naLUrc of applicant) Cpnemleeron 6Wkee 6 9 `E" o FEB r 31993 `r v _ 4 ib T VAT '?;,,le 3 3 6 9 0 P~ EW ~0 y ~ ~ o O ? SOrB~ ,1„ N ga G,rovua wATF,G OF OLK CO. TAX /a1 .!/O. 00-/ZZ-ee% /lc .91/T//D.UY lW GEK/i4.//00I^/dKi .1a'et, A44, / -AYN.gRO ~.9tMfE.f~ L.t'~/o fe/arErae LOCar/OL/. /7r1,4ma/ -:A r0~,,f/OF~dUT/a(7L~0 .U Y ~/!!J!/TiYOLOr .t/. Y. FOU.UOArivd.000. 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