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Home My WebLink About8202-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED Certificate Of Occupancy No..a ! 09.7.~,-.U?DAT .Ep Date ......... 7~ay..~' 11/...; .............. 198.~. THIS CERTIFIES that the building ................................... Location of Property . a gll ............... L.a,q C ~ ~-.~.q q.d..9.r..l.y.e ........... L.a. qr..e.1 ..... House No. Street Hamle~ County Tax Map No. 1000 Section . 1 2.? ........ Block ... 0.7 .......... Lot . .~).0~ ............ Subdivision..La~.elw~.c~d F~t~ Filed Map No. 5..5~.5 .... LotNo 25. conforms substantially to tl~.Ai~plioettio~-for-Baitdiz~.Permit, her~tofo~-lrded, ta~~ da~)d- ~.-.'~': .- .-.".-.':: .-.-.".': .- .-.-.-.':':..-.-.-.-19':': .-,-~as:is~lla:~ at, g; g~ all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .a. l~?i.v, ate one-£a~i.~Ly dw~).l, ing .~.rtc~ acce~.s.or'y..do.I! p.e.n.~? ...... . The certificate is issued to .... Q~ ~..~ .~an. ag. ~;L~ ~r~.~r. ............................. (owner, ~e ~ of the aforesaid building. Suffolk County Department of Health Approval . ~ .- .S.0..: ] :!.6. ,.. ~/.~.~/. ? ~ .~.. R. 9 .b.t.....R ....V. ! ~- .1.a. ~ P. UNDERWRITERS CERTIFICATE NO .... ~..a~ 1 y.4.0. .......... ; ......................... · This is an updated Certificate of Occupancy which includes Building Permit # 8202Z~ issued 9/22/75~ and C.O. 9 Z7024 issued 5/12/76. Building Inst~ctor Rev. 1/81 FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8202 Z Permission is hereby granted to: ............. N~...8.~ef~ .~t~ ........................................ to .~.1~1.. '~e~.. erie.. $~i.3;y..dwe '~.~z in g .................................................................................... at premises located at '"~,~t,'"~: ...... '?[~WO~'"E'st,' ................................................................. ........................................................ :~.u~e.].~eeci.~ ............ ~! ............................................... pursuant to application dated .........................~t,"'";~ ............ 19.~.~[.., and approved by the Building Inspector. Fee $...1.~[, .~.~ ........ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certi icnle Occupnncy THIS CERTIFIES that the building located at .l~ ?.~/.li .~..~'.(~ ..... I'? !~ ~ !/.~.. Street Map No.~ ~v a e t u~' v0 9 ~o~ck No ........... Lot No....~. ? ............................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 5£:.P-{... ~[~, 19. ? ~ pursuant to which Building Permit No. ~. dated ........... g[.k'U...~.?,., 19.7..~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....P. I~?.l .v.a .T. If ..... 0 ~.~ .... ff. 1:~ N~: .~ Y .... .r).~.). ~.~..~. ! N. (.~. .................... The certificate is issued to ... ~).~'0 .... [~. [ .T~: ~? £. of the aforesaid building. Suffolk County Department of Health Approval (owner, UNDERWRITERS CERTIFICATE No .... ~...~. ~ .I.? .~..D ........................... HOUSE NUMBER ..... NOTE - FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupnncy No,Z.6.89Q ....... Date ............. ?.e.b.....~.8. ..... , 197.6.. THIS CERTIFIES that the building located at ... ~%l~alWOo~l .D~Xv.® ..... Street Map No. La~.alwoo~ Block No ........... ~t No, ~. .... ~..~.,. ........... conforms substantially to the Application for Building Permit heretofore f~ed ~ this office dated ............. ~e~,. 22 19 .~. pursuant to which Building Permit No.. dated ............ ~p~. 22.., 19.7~., was issued, ~d conforms to all of the req~re- ments of the applicable provisions of the law. The oc~p~cy for which this certificate is issued ~s .~t~. p~. f~],4~.~y..~Vg~g ........................................ The certificate is issued to .q~. ~$~e~ ..... ~Z~ ............................ (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval ~qad~.~ .bY..q ~. ~b ........ UNDERWRITERS CERTIFICATE No. ~q~d~g ................................... HOUSE NUMBER ..... ~70. ..... Street.. ~el~nod. ~ ........................ ~0~. ~rge. hedro.~. ~e. co~d. ~loo~ .tz. ~ .~I~a~. ~. ................ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters, 4. Commercial buildings, Industrial buildings, Multiple ResidenCes and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .. ,~.~.z'.c.~, .8.,..],.9.8.2 ........... New Building ............. Old or Pre-existing Building .. X ......... Vacant Land ............. Location of Property . .470. ~e~L. ~oor~. D~±Te .......... ~eZ.,. ~]gs~. Z~. ~3-.94B ............. House No, Street Ham/et Owner or Owners of Property ... 0¢¢o. a~d[. Ua~-cy. W£.~eie~. ................................ County Tax Map No. 1000Section ..,1~7 .......... Block ...7 ........... Lot....5 ............ Subdivision.. 5s~eJ. wood[. ~s.~.tes ............. Filed Map No. 5.5.95 ...... Lot No...25 ......... Permit No ........... Date of Permit .......... Applicant ................................ ;. Ith D pt App al Hea e . roy .................. a or . ova ........................ Underwriters Approval . . ,~ ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ~./~. .............. / Fee Submitted $.. 5°00 .... '.~. ................. Construction on above described building a~ I permit meets all applicable codes and regulations. App,ica.t ........................ FORM NO. 6 TOWN OF SOUTHOED Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1, Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3, Approval of electrical installation from Board of Fire Underwriters. 4, Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5, Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2, Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Building .. Z: ......... Vacant Land ............. Location of Property . .470. La~trel. Wooc[. DriYe .......... Z,am~'e2.,. N~. Lr~:ck. 22.94£. ............ House No. Street Hamlet Owner or Owners of Property ... ¢.~.~a, Cn~, ;;"~tcb'. ~,~:i_22~e~'. ................................ County Tax Map No. 1000 Section .. ,1 ~7 .......... Block ... ? ........... Lot... 5 ............ Subdivision . . Laurelwood. Es.~a£es ............. Filed Map No, .5.5.9.5 ...... Lot No. , .2,5 ......... Permit No ........... Date of Permit ........ Applicant . ........................... Health Dept. Approval . '-' .Labor Dept. roval Underwriters Approval . . . ~., ~/./~. ..... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .................... / Fee Submitted $.. 5°00. ~ Construction on above described building a~ d permit meets all applicable codes and regulations. Appl,cant..~ ~;]~1 ~. ~.~' .~...../.~ / , , (/~. : ......... ,:"L: ......... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ ~ 85 JOHN STREET, NEW YORk, NEW YORK 10038 oa,~ May 5, ~976..,.,,.c,,.o,~,~o.o.~,~ ~3,8o~ N 281740 THIS CERTIFIES THAT Otto Wittmeler~ e/side ~70 Laurel Wood Drive, Laurel~ L.I. ~.s e.,,,.,i.,,,i o. May 3. 19 7 6 ..,t f,,,,~a to be i,~ cor~,pli.,~ce with the require ..... ts 'F this Board. DIMMERS S E R V I C HO OF HI-LEO 2 OF NEUTRAL 3/0 )THER APPARATUS' Motor/s: 1-1bp Panelbaard/s: 1-Salt., 1-17¢ir. 1 G.F.C.I 1-~.Skw Hot water heater 1-51amp. Heat Pumps, 1-?6amp. Heat Fumps Per~ , incorrect r~s~ectars m~v b~ed by their Board ~f This certificate must not be altered m any manner; return to t~~yu FOKM NO. 6 TOW OF $OOT OL0 , Building Deportment Town Clerks Office So#thold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and Submitted in DUPLICATE to the Buildlng Inspector with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from 8oard of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible far the building. 5. Submit Planning 8oard approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conformlng uses, or buildings and "pre-existing" land uses: T. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy 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 New Building ..... ..~........ Addition ................ Old or Cre-exlsting B~ilding ................ Vacant Land .............. Owner Or O ners Of Pr e,y ....... ..................................... Subdivision ...~/.~..~../../rff~.~../.....~.~..~...Lot No. ~ ....... Block No ............. House No ........ .,~.. Permit No.....~....~....~...?... Date Of Permit ..?~..~..~../..~.,~.Applicant . ~.,~.~.~7~ .ff, c~ff......~..~.~..~.~...~/.....~'C~.O..,¢~ Health Dept. Approval/~..~....!..~..!.~.Z..~....~.~..~..!.~/~.Labor Dept. Approval ............. .../~..../.~.. ........................ Underwriters Approval ~,~ I-7 ~ O Plannin- ............................................ ~ Board Approyal ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate ......... ...~... ........................... Fee Submitted $ ..:)..; .............................. Construction on above described building and it m,e~t~/~ll/,,~,p~lica,,ble codes and regulations. Sworn to before me this ~ ~// ~.& I ................ day of ....... ~.... (stamp or seal) Notary Public .................................... County FOF, D~ NO. 6 TOWN OF $OUTHOLD , ]Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--iS-9 form or equal), 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the 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 buildings and "pre-existing" land uses: 1. Accurate survey,of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent 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 Date ....... .¥..e...b.....~..8..,.. ,~.~ Z.6. ........... New Building ........~. ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... ,~/.~..,~.~],W.O.Q~..~),~..~,~,~ ....... ,T~U~P~...~.,.~ ........................................... Owner Or Owners Of Property .....O..t...t..°....~..Nane.y...i~i.tt~ie~. ................................................................ Subdivision .......~....?:..~...~.w...o. od ~states l-- No. 25 Block No ............. House No ............. Permit No. ,,.8...2. Q.~ ........ Date Of Permit ...9./.~.2../.Z..5..Applicant .,.~.p~.e.~.e...,G..,,...~..q~..o.9..,,~.,,,.S,p.,~s......~..~c, Health Dept. Approval ............................................ Labor De, pt Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ~ Fin~ Certificate Fee Submitted $ ....~..,.QQ. ...................... Construction on above described buildingrond permit meets oil qpl~lioabl~ codes and regulations. Sworn to before me this Applicant ~ ~~'~.~ ....... ...... ...... Notary Public ..... ~...~.~/...~.//~.~...i.4~.~.~. County ,,SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~, ~b-, ~",~ ~,'.,,-~, ~'?~ Phone ~'~- ~'~,~ Address ~ ~'. ~ ' .~ ',J ~'' 2. Propert~ Location ~ ~,-. ~,,,,,~. ~ ~, ~ ,~,,?,~ Village L~;..i,.. ~'' ..... ToWn~h~'P'--~;~:,.~;;~ ,~ t., 3. Public Water Company Name 4, Lot size: Width feet Length· feet 10, Sewage Disposal System: 5. Subdiv.! ~ ,,~ 6. Section 7. Lot Number 8. Private Well ,9. Public Water Distance to ~in (For Health Dept. Use) ll. A. 900-gallon septic tank: Precast_~Equivalent_____Block__ B. Leaching pools: Number of pools / Precast //Block Special__ fo! ! Dwi ng ~ anks: A.' Tank CalTacity ;'/'~ C~,'' Total~ell depth D Dept~'~o ground water in the jallons E. Amou~ of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated b~low and may be renewed if a current local Building Department Permit is in effect. Date '~ - L .... ' .......................................... ~ L-[~ .... .-£.~_~ FOR HEALTH DEPARTMENT USE ONLY, Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. ~/~~[/~(C~.~ ~ U~ ApPROV^ DATE__ SI NED . = S-15 Rev. 4/1/73 BUILDING DEPARTMENT TO~ OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location... 470 Laurel wood Drive (number & street) Subdivision Laurelwood Estates Map No. ... Laurel~ NY (Municipality) 5595 Lot(s).25 Name of Owner(s) ..o~..%.o ~ Nancy Wittmeier Occupancy Admitted by: unoccupied. (owner,tenant) Accompanied by:. Key available F%rst Towne Real~y Suffolk Co. Tax No. ]27-07-005 Source of request Joseph Fen~.gn Date 3/8/82 D~LLING: Type of construction Foundation Total rooms, 1st. F1 .. y Bathroom(s) 2. Porch, type .. Breezeway ...... Type Heat.. heat pu~p Fireplace(s).. 2 Domestic hotwater Other wood framed poured cement Deck, Garage 2 #stories 2 Cellar.,~,~l Crawl space,,, 2nd. F1 . 3 3rd. F1 Toilet room(s).. ] type ....... wood Patio, type car ~ room laundry room Warm Air × Hotwater No. Exits 4 . Airconditioning Type heater electric X ^CC, ESSORZ STaUCTUa S: Garage, type const. Swimming pool Other dog pen .... Storage, type const. Guest, type const. This is an updated C.O.--building permit 8202Z issued 9/22/75~ Remarks: C.O. issued 5/12/76~ # Z7024. Curtis W. Horton Time start3:~0 .. end 4:00 VIOLATIONS: Housing Code, Chapter 52 .. Location .... Descript.i..gn Ar~. Sec. cell.a.~ op.g.n side of stairs ... II !52-27-B 9/82: Violation removed. ...... .....7 ......... TOWN OF $OUTNOLD /~ '~/7~1- ' ~UTHOLD, N. Y. .......~ · ........................................ ,, , o Oisopprov~d ~/c ...~.....ffi,....~ ...... ............................................................................ -,'"F ...... ~ ............... ;'"' ~ -~ ~,~e~ ~//V:~ ,.~/ /~.~ ~., APPLICATION FOR BUILDING PERMITg~ ...... a. This ~pplicmion must be completely filled in by typewriter o¢ in~ ink and submitt~ Inspector, with 3 sets of plans, accurate plot plan. to. ~ale. Fee according;to sch~ule.. . b, Plot plan showing location of lot and of buildings on premises, relationship to adlommg premm~r p~ streets areas, and giving a detailed description of layout ofproper~ must be drpwn on the diagram which is po~ 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 s~all 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 aCe~ificate of ~cupancy shall have been granted by the Building Inspector. //~ ~ ~ APPLICATION IS HEREBY MADE to the Building Department for the~issuance of a Building Permit pursbant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New;York, and mher applicable Laws~ Ordinances or Regulations, for the construmion of buildings, additions or alterations, or ~or removal or demolition, as herein described. The applicant agrees to comply with all applicable aws, ordinances, building c~e, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for n~essa~ i~ections. (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. Contra .top Name of owner of premises Ot Lo Wittmeier ....................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .... ~.,d,..,,"!.,c}.'}~,i, 1,.'.l,~..P. .................. Electrician's License No. .~l,¢L..,9,e.;b:hF~e~7~ ................ Other Trode's License No ............................................... 1. Location of land on which proposed work will be dane, Map No,: ...~.~..~.~.e...1,..}:t,.o,,,o.~.,..~..s,.~. Lot No...'.2: ................... Street and Number .... .~Lg,~O.~,PZe'P*.0,......D...P..~.Y,9. ......... ~..]:.,...-: ....................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy Of proposed construction: a. Exisiting use and occupancy Yaoa.~}..~. ..................... i .................. ; .......... one familY' dwelliZ~ b. Intended use and occupancy ............................................................................................................................... 3. Nature of work (check which applicable): New Building....~.~ .......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior, .................... Other Work ................................................ , .... (Description) 4. Estimated Cost ............. .60.,.QD.Q0..'ff. ........................... Fee ....... .1..Lk~'...~..~. .................................................................... (to be paid on filing this application) 5. IF dwelling, number of dwelling units ...... .9..~..e. ............... Number of dwelling units on each floor ............................ ff garage, number of cars ..~.~.o. .................................................................................................................................... 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 ............................ Numb,er of Stories ................................ 8. Dimensions of entire new construction: Front .~ ........ ~..c~. ...................... Rear ....... ~..c). ................ Depth ....3~..Z'.,~). ..... 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 premises are situated .!!~.!!...c~.~.S.t2 ................................................................................ 12. Does proposed construction violate any zqning law, ordinance or regulation: .~..O,. ................................................... 13. Will lot be regraded .........~4~ ............ Will excess fill be removed from premises: (~c) Yes ( ) No 14. Nome of Owner of premises ....... O.%t~./d4.C~.C,~e.$e.~ ........... Address ................................ Phon~ No. ...................... Name of Architect .............................................................. Address ................................ Phon~ No ....................... N~me of Contractor ..~.?.~,o,~.,~.o,.t~..~,.~.S..o..~..~...'.Z,.~.~.a., ........... Address .....~.~{...~.~.z..~.~.9.~.~.. Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. SI'ATE OF NEW Y,~.RI(, lc ¢ COUNTY OF ....... ~.~'~.. ,o. ].~ ........ ~.; ...................... ~B.V.'i ~..J~.oz,.'~,c)~ ............................................ being duly swarn, deposes and says that he is the applicanl (Name of individual signing contract) above named. He is the ................................... .QP~.~.~.~..~...~.Q~...~;~$9.~. ................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the app~tion filed therewith/ Sworn to before me this /~ ~ ~ / /~ Nota~ Public,. ................................................... Coun~ ..,~.,~ ~.~ ........................................ x ~ignature of applicant) ~ 'T-r~.~tCorn?any a.d to