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HomeMy WebLinkAbout29268-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29383 Date: 04/24/03 THIS CERTIFIES that the building ACCESSORY Location of Property: 250 LONG CREEK DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 55 Block 4 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 8, 2003 pursuant to which Building Permit No. 29268-Z dated APRIL 8, 2003 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 INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to KEVIN & VERONICA GRATTAN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. H 285646 08/09/93 PLUMBERS CERTIFICATION DATED N/A Authorize Signature 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) PERMIT NO. 29268 Z Date APRIL 8 , 2003 Permission is hereby granted to : KEVIN & VERONICA GRATTAN 250 LONG CREEK DRIVE SOUTHOLD,NY 11971 for CONSTRUCT AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. THIS PERMIT REPLACES BP#21557Z . at premises located at 250 LONG CREEK DR SOUTHOLD County Tax Map No. 473889 Section 055 Block 0004 Lot No. 005 pursuant to application dated APRIL 8 , 2003 and approved by the Building Inspector to expire on OCTOBER 8 , 2004 . Fee $ 150 . 00 Authori-2ed Signature ORIGINAL Rev. 5/8/02 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) DareC/ ............................................ 19.� . . N° 21557 Z Permission is her y Ted t IrlI "41 , 640 ...................... .Gv,... ..... .....9..f................................................ af,... r ........�..../.../.... . .... Ta C�9rScccJ .. : . .9w .... �...... .GC......'�'�f.��1�1� ...... ...... �. .......................................................................................... ......................................................................................................................................I........................... .................................................................................................................................................................. .................................................................................................................................................................. at premises located at....a l Q..... !(P7) p .�.. ..... �✓ .......................................... ...................................................................�'4. ...4r.�"/•••�...l/.............. ...................................... County Tax Map No. 1000 Sectlon ...........1.ti J...... Block.........T............. Lot No. .... pursuant to application dated ......71a.. ..................................... 19...7..✓:........ and approved by the Bullding Inspector. 7 �� Fee .. ..................... Ilding Inspector Rev. 6/30/80 flsAP Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL - .. 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY At k Q 2003 This application must be filled in by typewriter or ink and submitted to the Building Departmei{t with the following: A. 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 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- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00, Commercial $15.00 Date. New Construction: " Old or Pre-existing Building: (check one) --Location of Property: y 4) cY/r/ C ( 2!P Y, 10! House No. Street Hamlet Owner or Owners of Property: /l t✓/!V 6 /� /�'l 1 12� T 7 f) 6) Suffolk County Tax Map No 1000Section Block Lot Subdivision Null -6-i Filed Map. Lot: Permit NDate of Permit. J v Applicant: Health Dept. Approval: Underwriters Approval: t J Planning Board Approval: Request for: Temporary Certificate Final Certificate: < (check one) Fee Submitted: $ /C¢C b3_707 Applicant Signatur f THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1185077 BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK. NEW YORK 10038 Date AUGUST 09, 1993 Application No.on file 04843693/93 N 285646 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 KEVIN GRATTAN, 250 LONG CREEK DRIVE, SOUTHOLD, N.Y. in thefollowinglocatAig ;USOBt ElIst Fl. 11 2.d Fl. OUT Section Block Lot was examined on MUST 2aagrng 19 9 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS TACLES SWITCHES INCANDESCENT[FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. M.P. 1 1 1 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS SELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. dl NO.OF FEET M.P. GAS M.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. M.P. SYSTEMS AMT. WATTS SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TVPE � 1 X 2W! 1./3W 3 AV 3W 3 0 4W NO-FCC.GOND. OFC W.OND.NO.OF HIAEG oA*W.0.H!WLEO NO. NEUTRALS OF A. W.0.PER& AI OTHER APPARATUS: SWIKKING POOL-1 TINE CLOCKS-AKP.40-1 G.F.C. I-1 HOTORSel-1.5 H.P. G.F.C. Ir -1 *(SVIKKING POOL) This certificate "vers compliance at the date of inspection only. Because of unusual environments it is advisable to <<< Continued on Page 2 »> GMNRAI. 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. DOPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 2 1185077 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Dote AUGUST 09,1993 Application No.onfile 04843693193 N 285646 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 KEVIN GRATTAN, 258 LONG CREEK DRIVE, SOUTHOLD, N.Y, in thefollowinR location; M Basement ❑ lst Fl. ❑ 2nd Fl. OUT Section Block Lot was examined on AUGUST 0 2,19 9 3 and found to be in compliance with the National Electrical Code. FIXTURE RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS �IICWACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FIIEDERS SPECIAL REC'PT TIME CLOCKS "LL UNIT HEATERS MULTI-OUTLET DIMMERS OIL H.P. OAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.►. SYSTEMS AMT. WATTS NO.OF FEET yh SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TOE IM� l's 3W 1/3W 3 Ar 3W 3,8'AWNO.OPER GOND. OF CC. OND. NO.OF HIAEG OF HWI LEO NO. NEUTRALS Of.W. 0. TRAL OTHER APPARATUS. have frequent test/and or repairs made by a qualified person. ROSLAK ELECTRIC LIC.#3677-E P.O.BO% 164 CUTCHOGU6 , NY, 11935 GENERA MANAGER 11 J Per This cei:f1c" mutt not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. CO FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. B � I A I — D 7 T C L LIJ, E F ►a'°'--- G — O00001 H J �-- KJ OF SIZE A I B I C I D I E IFIGIHIJIKILI Note: Diagonals given to14'X 28 14' 28 7' 3'4 8 1 12' 1 4' 4' 4'6` 5' 3'8" 900 point of corners. Is X 32 16' 32' 8' 3'S81 14 5'6N 4,6" 4'6N 7' 4'8" 18' X 36 16 36 8 34 12 14 56 46 46 9 4'8' 20'X 4 20' 40' 8'6' 3'4" I - I -7{' 4' 6' 8' 5'2" '— T E-0 l IT SET 4•CaNCRETE DECK R*M MED DEC) 8%A 10/10 W.W.F. O ♦•.9NINIIM COPING 1 ° 6 =.,;4,,;.•.AREA 4 SANK PUN wave O11 'ILL ,AMb L . UNDISTURBED °ARTM 4 s/e•X 2 B/:BOLTS USE NO EXPANSIVE MATERIALS FOR BACKFILL O SET VINYL LINER ,/B"REBAR OPTIONAL CRAY RECLINED IN CERTAIN STATES RAIGHT SET T. Of fly � � ADJUSTMENT Pa STANDARD BRACE r i Lit gctQ>.'ERMICULITE OR A , _• 1r kr i T!a `� Ij}sr CONCRETE FOOTER t Y T F, } f� ,BOTTOM 4'DEPTH MINIMUM ERCMTNM NOBS: `` S, L L4 r, E'`�lwyef ! STAKE TAMER 1. BOR. 10 HAVE MINIMUM BEARING AN J.,. It 1111�7 G a Eo00 P.B.F. g� , 9. LOCATE TOP OF POOL AT LEAST a• Ae sit'ReDsD"N} RAiROUMDINO LAND ELEVRTION. XREOIII�O PER YI �PAOGRESDSIOGNAM S. EXCAVATION SHALL K fs LARGER THAN FOOL A PERI MILttAN LS RHO. MY� VOI L"E BASE OF 4. BACKPR.L SHOULD MOT EXCEED RATER NEIONT A MO1ETIUM IE. WATER LEVEL SHOULD NDT ;LE EMAN It. NHT WTAMPED eADKFNL BY rove 510 SUMPTER DRIVE FORT WAYNE, INDIANA, x BACKFILL TO Of $AND,NAVEL OR OTHER 48904,U.S.A. 219.4329731 NON-EXPANSIVE MATERIAL (NO CLAY CONTENT). TYPE DRAWING NUMBERSCALE 0R#1V�f6V PRE 00 -1 3/32"= I' ^vertoveo eT MER SET DATE LIE STRAIGHT SET 3 RECTANGLE THIS BROCHURE 18 FOR ILLUSTRATIVE PURPOSES ONLY 4U Tho manufacturer makes only those repreSenlafioos which are staled in T is written warranty.Any other representations.Statements.or comreas 2S ARE 6"' RADIUS. E V E R�,,2 - made by the dealer and Or the contractor to the customer regarding any A BRACE. ALL CORNER materials produced by the manufacturer are attributable to the dealer and/ LRE I' X 1 . nr'ne contractor only The dealer Or Contractor who$0119 or installs your pool is an independent contractor and not ad agent or employee of the ma:mlactmer The conslruc0on methods illustrated Are suggestions and or,dy only to normal ground conditions There may be ad,il.onal preeau tle'sandlormethndsolcnnsbvclioo The rresponsibildyis the contractors. iimWn standards for residential pools. If diving boards or slides are to bP used P Pool insli!utPs minimum standards prior to installing divin hoards or clideg I A Prior Institute,2111 Eisenhower Avenue,Alexandria.VA 22314°703/1138 final ixy surer n vt• tt.w r .._._. N f7Tn Q uw. ft Ix M1 SYSr(tsu�y D It w.,w,r xt to". [tttuH a.o -o d..m K q,. .�,m,-...n,M f Y S y tl xR.['77w tq*mow.a PD1 Mi$ Si rtWw.0490"seumom a _ a—? N.35' 31' OG" F. — 175.0 4V 5� 1 �.,: .. ���� KG ""Moo "'. �t.nwua.c.r�.c4" HGF GSR J OF QCY +�t tbt..wi.•t1. M a +t.xmxw„xity w.tc... _M )AP CF P;201'- 2 T Z s?OW FX Sar , rfV SUR;r;YED FOP uot:secJ/ 1-DYNARi) t;. ANDER50N C,42.,6Z �W—E2 l t,tsoEc. cot+,t.}� ty AND �. P 16x32 3 , SJTUATfi AT _ < SOL' HOLD nn,{ , ! r� �-_ C�, TOWIJ OF SOUT40LO , N.Y.. !! �ye°FoaE a >a all NOTE 9E a LOT NU!lRFr2S SWOWN 2EFEZ TO "MAP OF %fE.MWB:!'0T7 PARK - FILE.13 IN TME SUFFOLK COUNTY CLE2K'S 0cp?C=_ AS .10AP M! 5187 S .c GUARANTEE!) TO THE TITLE 5UAZANTE5 COMPANY Aho TD IWE YOZTP FOZX BANE; s' ,'ANO TZ UST COMPANY 5' L1 r 2 SU2VE}'ED - AUGUST 4 1972 (.r1 pr= iu 'A N TIJ Y' SUN' u • 1-10` tJ%l E 11:T moommoommomm LICeNCS J LAND 5 K':EYOZS y1;z.14PO¢r, NEW Y01<sc 70-1802 BUILDING DEPT. INSPECTION I FOUNDATION IST ROUGH PLOG. FOUNDATION 2ND IN /SULATION I FRAMING �)41NAL I FIREPLACE & IMNEY REMARKS: DATE INSPECTO, M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ IN TION [ ] FRAMING [ ] FINAL [ ] FIREPL C IMNEY REMARKS: DATED "PECTOR n lELD IGS:'EOTiON JUATE COMMENTS 3 1 FOUNDATION ( 1st ) FOUNDATION ( 2nd ) 2 . \ Z 0 ROUGH FRAME & PLUMBING � N 3 . � m m INSULATION PER N . Y. STATE ENERGY CODE 4 . © FINAL z ADDITIONAL COMMENTS : m� En H 7] p� � 1 H H O Z r ' 2 m A S N ty. m H wW BOARD OF HEALTH . FORM NO. 1 3 SETS OF PLANS . . . . . . . . UU TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . i L BUILDING DEPARTMENT CHECK. . . . . . . . . . . . . . . . . . . . . i TOWN HALL SEPTIC FOR:1 SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ::OTIFY SO. . TO+A�N „ . . �--- CALL . . . . . . Examined ./. 3, . . . . . . . ., 19 NAIL T0 : �� 7 Approved . .0.. . . . . . . , IPermit No. - Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . "Auil o Inspector) APPLICATION FOR BUILDING PERMIT Q Date . . . .7./�� . . . . . . . ., 19 /3 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. :. . /Z'VAL-y. . f . .S5 . 1�t c: . . . . . . — (Signature of applicant, or name, if a corporation) (Mailing address of applicant) /( c(3-2_ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. �?.C�!6.✓. . . . . . .� 4�' �Cllz%?I7�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . . . . . . . . . . .�C�UI,J . , G i'L/9 y yt/. , , , . . . . . . . . . . . . ; , . . . . , . . (as on the tax roll or latest deed) If a lican is a corporation sig ature of duly authorized officer. . . . . . . . . . . . . . . . . . (Name and title Of c ate officer) Builder's License No. . . .a3.,;� -1 L4. . Plumber's License No. . . . . .n. . . . . . . . . . . . . . . . . . . Electrician's License No. Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. �. . . .clfa4c / aO. . . . . . . . . . . . . . ✓JKt�&: . . . . . . . . . .S. a'!� 1z �J . . .jA '.�... . . . . . .. House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . S r . . . . . . Block . . . . . L. . . . . . . . . . . Lot . . . . . .k,5. . . . . . . . . . Subdivision . . . . .Yt7-. . . .15�.Wlq. K. . . . . . . . Filed Map No. . . . . Lot . . a :3 . (Name) ' '. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . 9.6: t?d?,. T4e..-t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . mw Su��.�.o.l.uG ✓�4�C, 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . >( •• • • • • 1 (Description) 4. Estimated Cost . . . . . . . . . . .90.0 '. :a . . . . . I . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage, 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 ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . .t1csX t2 o-'7?7L. . • • • • • • • • • • • • • • • • • • • • • • • • • • • 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . v . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . y /� . . . . . . . . . . . . . Will excess fill be removed from premises: Yes 14. Name of Owner of premises . . . .(Vf.t.4?7?f.�. . . . . Address . . . . Phone No. . . . . . . . . . . . . . . . Name of ArchitectAddress . . . . . . . . . . . . . . . . Phone No. Name of Contractor .,;q .'•%4 �4 Y.! .Ste. . . . . . Address . . . TT 1 :��. Phone No. . . . . . 7. �F? 15. Is this property within 300 feet of a tidal wetland? *Yes. . . . . . . . No. . . . . . . . . *If yes, Southold Town Trustees Permit may be required. 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. S 24 APPROVED AS NOTED DATE: B.R 4 cFE BY: rsU7'!FY PUI!13!NG DCPAATruiENT AT 7%i5-i 802 9 Arv1 TCD 4 PM FOR THE FOLLIT.P IN INSPECTIONS: 1. FOUNDATION - TWO FiYr: PC%UREI)C0NCi,ETE 2. Fi£)UGH - FR,A!19 NG tit PLUMRiNG 4. �,Oi'VSTRUCTION M-',IST Ft 4.Of;PLE`¢F FOR C.O. ALL CO'"STRO i'ION SHALL MEET hF PEOUIREMENTS OFNTHE N.Y. STATE CONSTRUCTION & ENERGY CCsODES. NOT RESPONSIPLE FOR OFSIGN OR CONSTRUCTION ERRORS TATE OF NEW`]OI;IC� 'OUNTY OF . Gf/. . .. . .. . . . , , S.S , , . .NO K.�?! 19v, , , , ; , �b&/cc Y _ . . , , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bove named. eis the . . . . . . . . . . . . . . . . . . . . . . . .`.dY✓ Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) F said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief;and that the ork will be performed in the manner set forth in the application filed therewith. xom to before me this . . . . . . . . . . .�r� " . . . .day l.V�` . . . . . . . . ., otary Public, . . . . . . . . � �( County n. .c . . .'. . . . . . ROBERT L SCOT_7R NOTARY PUBLIC,State oflL1L N0.4725089,Suffolk b (Sign re plicant) Term Exyires May X1,19