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Home My WebLink About29271-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29398 Date: 04/29/03 THIS CERTIFIES that the building ALTERATION Location of Property: 50 SMITH DR S SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 76 Block 3 Lot 32 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 Per, nit No. 2927i-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 ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. Ge certificate is issued to JANET LYNN & ERICK C AUER (OWNER) of the aforesaid building. SUFFOLK COUIFrY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'£~D Rev. 1/81 N/A 74255C 04/16/03. 04/15/03 ERIK C AUER 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. 29271 Z Date APRIL 8, 2003 Permission is hereby granted to: for : JANET LYNN & ERICK C AUER 50 SMITH DR S SOUTHOLD,NY 11971 ALTERATION TO AN EXISTING ATTACHED GARAGE TO LIVING SPACE AS APPLIED FOR. THIS PERMIT REPLACES BP#26029. at premises located at 50 SMITH DR S County Tax Map No. 473889 Section 076 pursuant to application dated APRIL Building Inspector to expire on OCTOBER Fee $ 150.00 SOUTHOLD Block 0003 Lot No. 032 8, 2003 and approved by the 8, 2004 . 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) PERMIT NO. 26029 Z Date OCTOBER 13t 1999 Permission is hereby granted to: JANET LYNN & ERICK C AUER 50 SMITH DR S SOUTHOLDtNY 11971 for : ALTERATION TO AN EXISTING ATTACHED GARAGE TO LIVING SPACE AS APPLIED FOR. at premises located at 50 County Tax Map No. 473889 Section 076 pursuant to application dated MAY Building Inspector. SMITH DR S SOUTHOLD Block 0003 Lot No. 032 3 1999 and approved by the Fee $ 175.00 Above fee includes $~00.00 Flood Permit / Autho~d Signature ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANL~Y~__ - This application must be filled in by typewriter or ink and submitted to the Building Department with the folloWin~_.f A. For new building or new use: i. 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 New Construction: Location of Property: Date. / Old or Pre-existing Building: ~ House No. Street OwnerorOwnersofProperty: ZC'~Z-C_.. 4-~Ckff3¢.¥ ,~/~ Suflblk County Tax Map No 1000, Section ~'-~ ~ Block (check one) Hamlet O 0 ('~ '2~ Lot O~.-~ , Subdivision Permit No. & q,~'~ Health Dept. Approval: Date of Permit. Filed Map. q- ~° ~)~ Applicant: ~}/~'1~ Underwriters Approval: Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~ 5 Final Certificate: / (check one) Applicant Sign~t~tre Town Hall, 53095 Main Road P.O. Box 1179 Southold, New' York 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: q~l~ ~0 ~ Building Permit No. Owner: E~Ci~Q Plumber: (Please print) d. ae4 (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this /~/~ day of ~,'~/{, ., 20 O~ (Plumbers Signature) Notary Public, --~/~/~ County RICHARD R. flEMSCHICK NOTARY PUBLIC, S~te of New York No. 8119850, Sul~k C0un~ Term Expires t/, Issue Date 04/16/2003 Electrical Inspection Certificate Electrical Inspection Service, Inc. Application Number 375 Dunton Avenue 74255C East Patchogue, NewYork '11772 (631) 286-6642 Issued To: ErickA~er Street: 50 Smith Drive Village: Southold Zip: 11971 Section; Block: Lot: Town: Southold Contractor: North Eastern Electric (L) Lic. # 4658-E Was examined and found to be in compliance with the National Electrical Code. Commercial [] NVDefects [] Pool [] lstFIoor [] Indoor [] Basement [] HotTub Residential [] Det. Garage [] Attic [] 2nd Floor [] Outdoor [] Addition [] Survey Switches Receptacles Fixtures GFI Heaters 5 10 8 1 Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps A/C Fans Microwaves Furnace Oil Gas Circulators Smoke Detector Bell Transformer 1 Meter Amps Phase UG/OH Jacuzzi Television CO Detector / Bldg. Permit: Other Equipment Hugo S. Surdi President Rough Inspection: 04/15/2003 Inspector: Ed Scavelli Final Inspection: 04/15/2003 Inspector: Ed Scavelli This certificate must not be altered in any manner. Inspectors may be identified by their credentials. JUDITH T. TE:F. RY TOWN CLErO{ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53(195 Mare Road P O. aox ~ Soolhold, New York I lqFI Fax (5161 765-1823 Telephone (516) 765 1801 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the two (2) new forms to be used under the of the Code of the Town of Southold Application" [FDP(93)], and "Certificate Special Flood Hazard Area [C/C(93)]. Town of Southold hereby adopts Flood Damage Prevent regulations "Floodplain Development Permit of Compliance for Development in TOWN OF SOU'D'!OLD Southold Town Clerk August 25, 1993 TOWN OF SOUTHOLD APPLICATION PAGE 1 of 4 FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: {jENERAL PROVISIONS (APPLICANT tO read and ~ign): 1.. No work may start until a permit is i..*sued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fuli"RI loc:d, state and federal regulatory requirements. 7. Applicunt hereby gives eousent to thc Local Administrator or iris/her representative to make reasonable i~spcetious required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO . THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCUP,~TE. SECTION 2: PROPOSED DEVELOPMENT (To be completed bv APPLICAN'D NAME BUILDER ADDRESS TELEPHONE ENGINEER PROJECT LOCATION: To avoid delay in processing thc application, please provide enougJa information to easily identify thc project location. Pro'Adc thc street address, lot uumber or legal description (attach) and, outside urban areas, the distance to the nearest intcrscctlng road or wcll-lmowa landmark. A sketch attached to this application showing the project location would bc helpful. FOP(93) APPLICATION PAGE 2 OF d DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT [3 New Structure [3 Addition ~/Alteratiou [] Relocation El Demolition [] Replacement STRUCTURE TYPE I~Residential (1--4 Family) tn Residential (More than 4 Family) 12 Non-resident/al (Floodproofmg7 [] Yes) [] Combined Use (Resident/al & Commercial) 121 Manufactured (Mobile) Home (In Manu- factured Home Park? [] Yes) ESTIMATED COST OF PROJECT ~..~ B. OTHER DEVELOPMENT ACTIVITIES: [] Fill [] Mining [] Drilling [] Grading [] Excavation (Except for Structural Development Checked Above) · [] Watercourse Alteration (Including Dredging and Channel Modifications [] Drainage Improvements (Including Culvert Work) [] Road, Street or Bridge Construction [] Subdivision (New or Expansion) [] Individual Water or Sewer System [] Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for re'dew. SECTION 3: FLOODPLAIN DETERMINATION (To Be c0mvleted bv LOCAL ADMINISTRATOR) The proposed development is located ou FIRM Panel No. , Dated The Proposed Development: [] Ia NOT located in a Special Flood H.zm'd Aa'ca (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). [] Is located in a Special Flood Hazard Area. FIRM Zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) [] Unavailable [3 The proposed development is loc. areal in a floodway. FBFM Panel No. Dated [] See Section 4 for additional instructions. SIGNED ~'[ ~'~-~ ~'-'~-'~ DATE ATTEI~ provide determ '.~ O.M B. NO 3067 0077 ,rill ,r-p · -. I[lll[ ELEVATION CERTIFICATE LJU! b£ I [J ~ II,~DERAL EMERGENCY MANAGEMENT AGENCY ~ ~ NATIONAL FLOOD INSURANCE PROGRAM 10 : se ca e oes r)ot provide a waiver of the flood insurance purchase requirement. This form is used only to alevatl~l~dl~t~la~sarv td ensure compliance with applicable community floodplain management ordinances, to ~e the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE POLICY NUMBER iOM~,~ ~AIC NUMBER ' BUILDING OWNER'S NAME Janet ~er STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O ROUTE AND BOX NUMBER 50 Smith Drive South OTHER DESCRIPTION (Lot and Block Numbers, etc) 1000-76-03-3~2 CITY STATE ZIP CODE $~ut-hol~], NY 1 197 1 SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1 COMMUNITY NUMBER 2 PANEL NUMBER I 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6 BASE FLOOD ELEVATION (in AC Zones, use depth) 360813 0166 G 05/04/98 AE El. 8 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): [] NGVD '29 [] Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: U~_: I I I.~ feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 1 . Hse. & Gal:. Floor 2(a). FIRM Zones A1 -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of I I I 111:2 I. J~ feet NGVD (or other FIRM datum-see Section B, Item'7). (b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of I I I ~ .L_J feet NGVD (or other FIRM datum-see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I [ 11.19J feet above ~ or below [] (check one) the highest grade adjacent to the building. (d). FIRM Zone AC. The floor used as the reference level from the selected diagram is b J ~. ~ ~ feet above ~ or below ~ (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? [] Yes [] No [] Unknown 3. indicate the elevation datum system used in determining the above reference level elevations: [] NGVD '29 [] Other (describe under Comments on Page 2). (NOTE: ff the elevation datum used in measuring the elevations is different than that used on the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: [] Yes [] No (See Instructions on Page 4) 5. The reference level elevation is based on: [] actual construction [] construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is: ~ i ~ ~9~.~ feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I I I I I I.~ feet NGVD (or other FIRM datum-see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81-31~ MAY 90 RE PLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones Al-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones An and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features-If the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. I certify that the information in Sections B and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME John T. Metzqer LICENSE NUMBER (or Affix Seal) 49618 TITLE President COMPANY NAME Peconic Surveyors, P.C. ADDRESS CITY STATE P.O. Box 909 SOuthold, NY 1197 S,G.ATURE o97 /99 ..ONE // I Copies sho6B be made of thiie/~edificate for: 1) community official, 2) ineurance agen~company, and 3) building owner. COMMENTS: ON SLAB ^ V ZONES ZONES ADJACENT GR~OE WITH ON PILES, BASEMENT @IERB, OR COLUMNS A A V ZONES ZONES ZONES' BASE FLOOD ELEVATION The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2 BUILDING PERMIT REVIEW CHECK LIST Reviewed' OWners Name: __ Architect/ Date Engineer: __ __ Submitted: Dis~'ict: ]~000 Section: ~ Block: ~ ~t: Project ~ ,~ ~/ ~ _ ~ ~. Subdivision ~tion: ~w Nme:~~ Single & separate Required certffication: (.Yes / No) Zoning Disu-ict: [Lot size: Actual: J [Lot coverage roposed: roject Description: AGENCY PERMITS REOUIRED FOR REVIEW N.A.j Suffolk County Health Dept. New York State D.E.C. Town Trustees Town Zoning Board approval: Town Planning Board approval: /~' Flood Pla~ Elevation ??? Flood Zone: Permit NO YES _Number ' ~' 765-1802 . __ BUILDING DEPt.~' INSPECTION/~~~?/ [ ] FOUNDATION 1ST [ D~' ROUGH PLBG? [ ~NDATION 2ND [ ]'INSULATION [ ~ F~MING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ ~/1~ .. ~ ' ~ ~ DATE ////~/~ INSPE~OR ~ .~ / ~ '--w~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ~~OUGH PLBG. [ ] FOUNDATION 2ND [,,~'li~SULATION [,/~F~MING [ ] FINAL FIREPLACE & CHIMNEY ,,,~.4.,(s: ~-~~.~~ DATE INSPECTOR//~7~/~ BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ,, ] I~LATION [ ] FRAMING [~**'] FINAL [ ] FIREPLACE ~_CHIMNEy_ _ ~'A) [NSPECT~LON REPORT ~DATE ................................ CO~I',FI'$ INDAT[ON (IST) $~TION PER N. Y. STATE ENERGY It CODE FINAL }{ ADDITIONAL CO{.fl"IENTS: FORH NO. I TO~/ OF SOUTHOLD BUILDING DI~--PAR~4ENT TO~I/ HALL SOUTHOLD, N.Y. 1]97l ~L: Di~ a/c .................................. "7' .................... ............ ~OG, 0~?, INSTRUCTIONS ?~1~ O~ ~TaOLO CALL .................. HAIL TO: .................... a. This application mast be cempletely filled in by type~iter or in ink and sel~itted to the Building Inspector 3 sets of plans, accurate plot plan to scale. Fee aeeordlng to sehec~le. b. Plot plan shooing leeatioa of lot and of buildings on premises, relationship to adjoining pr~ises or pablic streets or areas, and giving a detailed description of layout of propert7 mast be draan on the diagr~n ~hich is part of this application. c. The ~ork covered by this application v~y not be ccmmnced before isau~ce of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. permit shall be kept tm the premises milable for inspection thra~hont the ~ork. e. NO building dm11 be occupied or used in ~/~ole or in part for any purpose whatever trotS1 a Certificate of Occupancy shall have been granted by ~ Building Iaspector. APPLICATK~I IS tl/l~-~l PAIE to the Building Depmr,,--at for the issuance of a Building Permit pursuant to the BuiIding Zone Ordinance of the To~n of Sc~thold, Suffolk County, Nea York, and other applicable Lass, Ordins~ces or [~=~ulatic~, for tie construction of buildings, additions or alterations, or for r~m~val or ~lition, as bereio described. The applicant agrees to cc~ply with all ap~)~io~c~ie i.~s, .ord.lr~mces, building .cede, .lx~ing code, a~ (Signature of applicant, d~ nmm, if ~ cor[/oration) (roiling ~aare~ of ~pnc~t) ~\Cl'~ State ~i~ether applicant is o~r, lessee, a~mt, ardaitect, engineer, general ceetractor, electrician, plm/~er or beilde .. ... ................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nme and title of corporate officer) Builders License No .......................... Pl~bers License No .......................... Electricimm License No ...................... Other Trade's L/cease No ..................... 1. I~'.ation of land on ~hiah proposed ~ork will be done .............................................................. tiomm Rk~ber St~,,.t _.~ Bamlet ~ivisi~ . ~ .... ~ .................. Fil~ ~ ~ ................ br ............... (~) State ~sti~ 2, .. .... , ........... 3. 10~ture of ~ork (check M~id~ applicable): Ne~ I~Jilding .......... b~ldition .......... Mterati~ ..~..... ~ir ............ ~al ............. ~llti~ ............ Oflmr ~ .................. ~ ............... ~ri pti~) ~. Estimc~ ~s~.~..~ ........ f~ .............................................. (~o ~ ~id ~ fili~ this a~li~ti~) L I~ ~lli~, ~r of ~lli~ ~mi~s ............ ~r of ~lling ~iCs ~ ca& ~r ................ If ~r~, ~r of ~rs ...................................... L If ~i~ss, ~rcial or ~ ~, ~i~ ~e ~ ~tenr of ead~ ~ of ~ ...................... .. ,.~i~ o~ ~i~ ~, i~ ~: ~...,.~.,.... ..... ~i~, ..i'5.~.k .............. ~ o~ s~o,i~ ..:.~ ................. ~pth ...& l..kk-f..5, tO~i~c ...t~ ~ ......... ~ o~ ste~i~ .... I .......... L Di~nsi~ of enti~ ~ ~st~ti~: ~t ................ ~ar ............... ~p~ .............. ~i~ ......................... fie ~ o~ ~o~i~~ ..................... L 5i~ of lot' ~t ~6 ~ ,~O__e ~pth lO. ~te o[ ~ m ............. m ............................ I I. ~ or m district in ~i~ p~i~ a~ ~i~t~ .............................................................. 12. ~ ~ ~t~tim violate ~ ~i~ 1~, o~i~e ~ r~latlm: .... .~. I~. ~ill lot ~ ~ ..... ~ ........... ~ill ~*~ Jill ~ ~ o[ ~it~r .... ~mss ............................ ~ ~ .............. 15. Is this p~ ~in ~ f~t o~ a till ~tl~ ~ ~ .......... PLOT DIAGRAH Locate clearly and distinctly all buildlng~, ~/aether mdsting or proposed, and indicate all sst-hack dimensions Gou property lines. Gixae street and block n~ber or description according to deed, and sho~ street hanes and indicate ~aether interior or corner lot. Aec, .......................................................... being duly ~rn, deposes and says that he is tbe applicant (ltane of individual signing contract) i~ is the ................................................................................................... (Contractor, agent, corporate officer, etc.) )f said tamer or tamers, and is duly authorized to perfonn or have perforned the ~ald work and to make ~ file this application; that all statements contalned in this application are true to the best of his knowledge and belief~ and khat the w~vkwi[l be performed in tl~ n~nner sst forth in the application filed tbevew{th. ~orn to before me this 0 ST6008173, Suffolk Cou~v Tefra Expires June 8. ($jgna~tute o~ ^ppli. cant) ~-t 0 :ti