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Home My WebLink About4811-zFO~.M NO. 4 TOWN OF SOUTHOLD BUn'.rqNG DEPAR'I'&~'T Town Clerk's Off/ce Southold, N. Y. CertifJczte Of Occupancy THIS CERTIFIES that the building located at ... R,0 ,W,R/$. J~egon .Roa~Street Map No.. JCX~ .......Block No.. XXX .....Lot No. XXX...Cutchogua..~oX, ......... conforms substantially to the Application for Building Permit heretofore fi/ed in ~is office dated ...........k!vx" · 0', a?~. pursuant to which Building Permit No ...... 6~71Z ments of the applicable provisions o! the law. The occupancy for which thi.~ certificate is issued is P~'iva.te. on~ .£a~lly. d~ellin& .&. ac. ceszo~ry, kuild;Lng .............. The certificate is issued to. l%i~ua. Stevens ....... 0~mex, ........................... (owne~, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~.uly.. A 0...i97.~...by. B,. ¥;Llle.. UNDERWRITERS CERTIFICATE No.pending ..................................... HOUSE NUMBER... 13~0~. .... Street ... Oregon./~oade..~ui;chogue ............. '" Bui]dm~ ~ FOR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~811 z Permission is hereby granted to: ........... ~ ~....~ ..~.~.~ei~ ~a~....~]~.....~ ~eve~ at premises located at ............... ~g.~..~.f).,.~.....t~.[&..:~/.~..~.~O~..~l~ .................................... ................................................. .~.~.~ ......... ~.~,~., ...................................................................... pursuan,t to application dated ........................... J'.~f~......~.~. .......... ....., 19.,~.0.., and approved by the Building Inspector. ~O~t ~ ~]~2~O~ ~ ~~ ~O ~ ~O~ before C/O ~ ~.?~.~ .......... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTH'OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N96571 1 Z Date ..........................I'1?y.......... ......... 19-773. Permission is hereby granted to: : aatre s.............................. .....Q1~ .'an..R ..................................................... .........I;�;j:rY. ................................................. �.Z3 to ...T L1:Ild..w.Xb •anr+noo(��+s Qx. 191 t Ji.I i tY.•�U.g. ................................... .............................. •..........••......•.•...........................•...............................................•.................•....•....................................... at premises located at .. .: .4: r.... .. rP n1?..aC2md.................................................................. Cutcho ue I1.Y. .......................... .................................(?............... ................................................................................ pursuant to application dated .............................r)r,;r........ ........ 19....;73, and approved by the Building Inspector. Fee $.10...(10........... �..::'' i',,:..?.:....:�1......... .�� ...................... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH ~JUL 1 0 1914 Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. Chief of C~neral ~n~in~ering Sarvioe8 JUL ~ 0 1974 SUFFOLK COUNTY DEPARTMENT OF HEALTH .v., ~ EASTERN DISTRICT H.D.Ref. No. ' County Center, Riverhead, NewYork ~PA 7-4700 -?63 APPLICATION FOR APPROVAL OF INSTb~-T-~n PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYSTEMS Inspection for approval is requested, pertinent installation data herewith. 1-Name of Owuer~ 3-Subdiv. Address Phone &-Section No. 2-Name of Builder [~ /~,~..~ /~-~,~. Phone 5-Lot Number Address .~¢ f'~ r /~/ , /Fi~ ,'.~ . ' ~ 6-Bldg.Permit No. 7-Sewage System installed ~y -~.~,~.~,~¥/~.~ Phone Address .7, ~ ~. ~ , ~,, -~, ~ . 8 (a)Deed location of prop~r~y / ~ ~f ~ ~,~ ~ '~ - , ~ - -' ~o - / (c)T~n (b)H~let or Village eo~o ~k-Oal L ft.W ~ fi.Liquid Depth lO_Cesspools-(a)No.pools~(b)Blocks below inlet 1)__2) 3) , (c)Block stze-L In.W ,in.H tn. (d)Precast pool ,'e* ~.(e)1~2~3 (f)H .f~. tn; Dt~ f~'. tn.(g)Ftntshed grade t0 cover ft. (h)Back~tll Material /~~ · ll-Water Supply: Public Syst~ ; Private Well If Private, the roll.lng questions are to be answered: 12-Private Water Supp~ SysCo. installed by /~f ~ ~, P~ne Address /~ ' ~ ~ ~ ~ ~ q ~ ' 13(a)-Total Depth of Well ~"~ (b)Depth to Static Water Level~:)7~ 14-Diameter of well pipe in. 15-Name of ~bora~ory 161Method of Disinfection '17-Date ready for inspection ~e undersigned CERTIFIES: Above syst~s have been constructed and, are tn compliance with the Suffolk County Health Department's current. Stanford,S_. . BUl'letins and ~endments thereto. ~er -~ 19-Insert sketch of location of Water & Sewerage Facilities with accurate dimensions. STREET FOR HEALTH DEPARTMENT USE ONLY Znspected hy OSC Date Based - ~he ~formation stated above, satisfactory functioning of the upon above systems can be expected with proper maintenance and care. Date JUL 101974 ._ pproved Chief of General E~4~ineering Servi'oe~ S-Se FOR~ NO. 6 TOWN OF $OUTHOLDi , Building Deportment Town Clerks Office : Seuthold, N. Y. 11971 APPLICATION FOR CERTIFICATE OP OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and s~bm tted in DUPLICATE to the Building Inspector with the following; for new buildings or new asa: l. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. ~ 2. Final approval of Health Dept. of water supply and sewerage dispasal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple I~esidences and similar buildings and installations, a certificate of Code compliance from th? Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or I~uildlngs and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, .streets, buildings and unusual naturot or topographic features. 2. Sworn statement of owner or previous owner as to use, ?ccupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Mew Building ................ Addition ........... .~. Old or Pre-exisfin§ B~ilding ................ ¥ocont l~nd .............. ' ....................... ........... ......... "r ........... .............. ................. Owner Or ~ners Of Property ....~~~~...: ........................................................... Subdivision .~, ...................... ~>Z~...Lot No..~... Block ~ '~x~ ' ......... Heolth Dept. Approvol ............................................ kobor ~t. ~pprovol ................................................ Underwriters ~ ' ' /~ Approval .............................................. Planning B~rd Approval Request For Temporaw Ce~ificate ........................................ Fin~ Ce~iflcate ...........~ ....................... Fee Submitted $ ~ '~ Construction on above described building and~it me--cable c~es and regulations. Sworn to before me this L ~ .......... ' APPLICATION FOR BUILDING PERMI'f / INSTRUCTIONS a, This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location, of lot and of buildings on premises, relationship to adjo n ng prem ses or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is p~rt of thie application. 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 issue a Building Permit to the applicant. Such permit shc~ll be kept on the premises available for inspection throughout the progress of the work. __ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sholl have been granted by the Building Inspector. APPLICATION IS HERJ:BY MADE to the Building Department for the ssuance of a Building Permit pursuant to the RBeUiludi~tgi Zone. O.r.dinance.of the To, w.n .o,f, Southo!d., Suffolk C. ounty, New York, and other applicable Laws, Oidinanc~s or g a ons, Tot rne construction OT Duhdings, additions or alterations, or for remova or demo it on, as berlin de~x:rJbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations. (Signature of applicant, or name, if a corporation) ...................... ................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem ses ~..././../~.~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No.: ........................ Street and__~umber ........ ~....~...~..~...~.~.....,~. ......... ..~..?....Z~...~..../~...~....~. ~ ~ ..a ..'~.:..~...'. ' ........ .......................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................................ b. Intendeduse and occupancy ....... /.. ........ ~,~,Z.~.~ ..... ~.. ........ ~ ............ ~ ...... .......... 3. Nature of work (check which applicable): New Building ~. .... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4 Estimated Cost .............. .~.. ~ ..o..?...~......-~.. ....................... Fee .......................................................................................... (to 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 ......................................................................... : ............................ i ............ : ......................... 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 same structure with olteratioos or additions: Front ....................................Rear ............................ Depth ................................ Height ........................ ......Numl~er of Stories ............................... 8. Dimen~sions of entire new construction: Front ...~..~.~,.~.~....'.:.i ........... Rear..........;3 {4 ......... ~ ......... Depth .~T.~...../. ............ Height ...../..~.../. ...... Number of Stories ......... /.' .......................................... ~'.~....~'..'..' ................................................... 9. Size of lot: Front ....~.....~...~,' ........... Rear ......~...'~....~.....~ ................ Depth ...~/..~.~..?..:. ............ 10. Date of Purchase .......... ~..~.~::~.. ............................... Nome of Former Owner':~.~./~L~...~....'/~...~'..~...Z...~.......~..?.: ......... 11. Zone or use district in which premises are situated ...... ~...(~...../..~....~.'~,~..'.~...~...~...Z:..i 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~..~.' .............................................. 13. Name of Owner of premises~'/'~/~'"'"~"~"~'"~"'~'"~""~'""~'""Address~ -- .-) ~'~ ~(,z~-~/,/- /3~ Z ~_ ~,"~'"~'"1~'"'~"~"~'"~'"~'"/'"~"~'"' P~=hone No. ' Name of Architect .~;.{E~.{~...~....~.~.~.../.~./'~7.;...~.;'.:.~r~sS//./..~...¢..~.........~..~...~..~.~.... Phone No. '~ Name of Contractor ~.~,~/~'~./..~'.../..~.../~...~'../..~..?....~....~'.....Address PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all s~t-back' dimensi~on$ from .~ property lines. Gige street, and block number or description according to deed, and show street ~ar~e~ and indicate · whether interior or comer lot, COUN~ OF ................................ ~a.a.~ ~¢ ~-* -- .............. ~..~'~.~.~.~' ~ ..................... being duly sworn, d~oses and says t~t he is the applicant (Nome of individual signing appfication) ,bo~e n,~,d. H, ~, the ..... ~..Z.~.~.~...; ...... ;; .................................................................................................. ~ .... (Contractor, agar, co.rate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements contain~ in this appli~gtion are true to the best of ~s knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith Sworn to before me this ............. o, ........... ........... , - __ , - ~ ~.~ /~/~ Fl ~_ ~ ~ .... ~~....~-.~' -~:-~:~ ....................... Nota~ Pu~,~U~Z~~o.n~~ (Sig.amre of app"ca.t) ~, ~ of ~erm ~ ~ ~ ~, ~ FORM NO. 1 ' TOWN OF SOUTHOLD BUILDING DEPARTMENT ;� ( �, fc6w �.✓� TOWN CLERK'S OFFICE SOUTHOLD, N. Y. aZ47rl Examined .....,p1� ..r.��........, 19........ Application No. ................................ Approved ................`......... ........... ., 19.73. Pemit No. ..5�.. Disapproved a/c ................................................................................ ............... �z6/7s .... ......... ................................ (Building Inspec or) Gv APPLICATION FOR B IL DING PERMIT �1n- O \ Date .......C """'........................... 13......�I 0^'I'`� INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with? 3 sets of plans, accurate plot plan to scale. Fee according to schedule. T b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, andc giving a detailed description of layout of property must be drawn on diagram which is part of this application. 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 issue 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. , 7 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 bui ings for nec ary inspections. (Signature of`*T)plic`nt,or name, i a corporation) ..................................... . ... �. �.ji.r (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Architect ................................................................................................................................................................................................ Name of owner of premises .....Nina...A teVeu.9........................................................................................................ If applicant is a corporate, signature of duly authorized officer. ................................................................................................... IN (Name and title of corporate officer) Builder's License No. ......................................................... Plumber's License No. ........................................................ Electrician's License No. .................................................... Other Trade's License No. .................................................. 1. Location of land on which proposed work will be done. Map No...............................................Lot No. ........................ Streetand Number ............QrAgAxi..Raad.................................................................................................................. Municipality 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 .............Restder.tial..auxilla y...structurs... ........................................I f 3. Nature of work (check which applicable): New Building ..... ............... Addition ..................... Alteration.:............. Repair ......................... Removal ......................... Demolition ........................ Other Work ................................... : (Description) 4. Estimated Cost ....... Q.OA............................ Fee .../.6... .. .. ... ................................ ......... ...... ....... ...... ..... ........ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....I........... Number of.dwelling units on each floor ...1................................... 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 same structure with alterations or additions: Front ........................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front . 14.:.......... Rear .........141............ Depth .....32.1...................... Height ....17..!....................................... Number of Stories ....I...al d..Iof:t............................................................... �. 9. Size of lot: Front ... SO.:......................... Rear ....550.1............................. Depth .. .2200.'................................... 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 regulation_:.......no................................................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: [ ] Yes [x] No 14. Name of Owner of premises ....... ............ ..... ...... ................................. ......... .. .............. �(Address)� - �(Ph'one No.)�� Name of Architect Xftl x>,d.. Y.e s„Jr,......2A1„Et!;,,78 St.,,,, N.Y..,N.Y.10021 988-523......... ............ .... .... .... .. . ... .. .... ......... ............. (Address) (Phone No.) Nameof Contractor ...........................................:..................:.:....:.(Add ress......,.....).......:.................................:......................... (Phone No.) .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 r description according to deed, and show street names and indicate wheth- er interior or corner lot. AM — c '> — —— Acctvp R, STATE OF'NEW YORK, ) SSCOUNTY OF .................E.ftvnA Stevens J-r. being.duly sworn, deposes and says that he is the applicant above named. ........ ...................................................... (Name of individual signing contract) He is the ............................Ar.chite.ct............................... ............................................................................................................................... (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 aretriie d e and belief; and that the work will be performed in the manner set forth in the plication filed',therewith. Notary Public, State of New Yorrr'-, C. 60-3134045 ual. in tc ester C Qo. — r.rrtifi ate Filed in New r ount y . - . .................. ay of ......... ... . .. ....... ernr:••�spites•D'lac�;l� ,.�7.7.. Notary Public, ................. County ....................... .................."......... ..................� ......................... ISionature of apnlicant) 'S' a ►,� ' ]FORM NO. 1 TOWN OF SOUTHOLD y BUILDING DEPARTMENT TOWN CLERICS OFFICE SOUTHOLD, N. Y. Examined .... ........L ......... 19...7� Application No. S?...5 �.�................... Approved ....,..d'. t... . . ...:`..� .:, 19:�1.--Pemit No. S?...�........ . .......... Disapproved a/c .:...............................................:... .... ...... ........................ .. ...................... ..................................................................................... - — - — ........................... ..... ........................... .................................. (Building Inspecto APPLICATION FOR BUILDING PERMIT Dote .............. ..�........... 19 .... ..., INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink .and submitted in triplicate 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 pWmises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which is part of this application. 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 issue 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,Suffotk 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 +rigs for necess ry inspections. (Signature of applicant,or name, if a corporation) .... ..... .. .. .. V ................. (Address of applicant) State whether applicant is' owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Architect ....................................................................................................................,:........................................................................... Nameof owner of premises .....W;Wa..A. .S.tAV.extS.....................................:.............:..................................................... If applicant is a corporate, signature of duly authorized officer. ................................................................................................... (Name and title of corporate-officer) Builder's License No. ............................................:............. Plumber's License No. .............:.......................................... Electrician's License No. .................................:.................. OtherTrade's License No. .........:.......................................... 1. Location of land on which proposed work will be done. Map No...............:..............................Lot No. .............::......... Streetand Number ............Qr.egon..aaa_d.................................................................................................................. Municipality. 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, .............Rasidential..auxillaxy...structuts...........................................�, ,.,') .:.--•.t Imo'" ' 3. W itufe of work (check which applicable): New Building .....A............... Addition...................... Alteration............... Repair ......................... Removal ......................... Demolition ..............:e........ Other Work ....... ........ (Description)�� 4. Estimated Cost .......S.aA.QQ............................ Fee .1 0...J. .. ... ................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ... ........... Number of dwelling units on each floor :...I...............:.................:. 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 `l ...................... ................................... Height.................. ...................... ................ Number-of.Stories ........ . - ...... ... .......... . ................. Dimensionsof same structure with alterations or additions: Front .............:............ Rear ......................................... Depth ............................................. Height Number of Stories 8. Dimensions of entire new.construction: Front ........14' Rear 141 ............ Depth 32 Height ....1.2.!....................................... Number of Stories ....I...axe.d..IAtt.............................................................. 9. Size of lot: Front .... ,qQ..'......................... Rear ....550.:............................. Depth .....2.200.'.................................... 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 regulation: 13. Will lot be regraded _no............................ Will excess fill be removed from premises: [ ] Yes (39 No 14. Name of Owner of premises ....... ............................................................................................ (Address) (Phone No.) Name of Architect dul]�3�C�d... �Y.tQXIg„Jr,......g41 . .. . ...... .... „E,w78 St..,., N.Y..,...Y.10021. 988-5................523 .� ......... ...(.Address)..... ......... (Phone No.�23 Nameof Contractor .............................................................................................I..... ...........,...:.............. (Address) ..................(Phone No.) 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 Qr description according to deed, and show street names and indicate wheth- er interior or corner lot. Nit lia yr &Ct?v- l2, TATE OF NEW YORK, /� ,SS OUNTY OF .................... .... ..............:.............) ............... ..... ..;tevens Jr.• •,.. ...•.• • •••..•.....••.. being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) e is the ArChi.f~eCt;........................... (Contractor,agent, corporate officer,etc.) t 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 :atements contained in this`application are true_.eq0 X0ej I�jTppAedge•and belief; and that the work will be performed in the manner !t forth in the application filed therewith. Notary Public, State of New Yor& -, s� 7 j �� c 60-3134045 Qua1. in \,N? tc cstcr Co. d ant, ( �rrti�F_i ala Filcci :n Nr.� ounty, ...............I.............. ay of ....... iYei-n..hxpiros•�1ac1� 3U,.�1].. VotaryPublic, .... ..............................................1................. County ..... ..................... . ..........................�