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Home My WebLink About26369-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26960 Date: 03/06/00 THIS CERTIFIES that the building DWELLING Location of Property: 1145 NOKOMIS RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 3 Lot 28 Subdivision Filed Map No. __ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 20, 1963 pursuant to which Building Permit No. 26369-Z dated MARCH 2, 2000 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING BUILT IN 1963' The certificate is issued to ADELE COSENZO of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-00-0044 03/03/00 ELECTRICAL CERTIFICATE NO. PENDING 02/25/00 PLUMBERS CERTIFICATION DATED N/A *U~J.ING ~JILT IN 1963 ~ ~ E~P~ Authorized Si~natur~ Rev. 1/81 FORM NO. 3 TOWN OP ~OUTHOLD 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. 26369 Z Date MARCH 2~ 2000 Permission is hereby granted to: ADELE COSENZO 740 NAKOMIS RD SOUTHOLD~NY 11971 for : CONSTRUCTION OF ONE FAMILY DWELLING. (THIS REPLACES EXPIRED BP #2274Z DATED DECEMBER 20~ 1963) at premises located at 1145 NOKOMIS RD County Tax Map No. 473889 Section 078 Block pursuant to application dated DECEMBER 20, 1963 Building Inspector. $OUTHOLD 0003 Lot No. 028 and approved by the Fee $ 225.00 AuthSriz§d Sig~ture Rev. 2/19/98 ORIGINAL BUILDING DEPARTMENT TOWN ItALL 765-1802 APPLJCATION FOR CERTIFICATE OF OCCUPANCY This appiication must be filled in by typewriter OR ink and submitted to the buildin inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property ]ines streets, and unusual natural or topographic features. 2. Final Approval from Health Dept,.~ of water suppIy 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 i% lead. 5. Commercial building, industrial building, multiple residences and s~milar buildi and installations, a certificate of Code Compliance from architect or engineer responsible for thc buiIding. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, i957) non-conforming uses, or buildings a "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applican 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ~c~ ~,2o00~ . .. New Construction ........... Old Or Pre-existing Building .............. Location of Property 11~5 NOKOMIS RD~ ~I~RQIJl ~.~ ....... House No. Street Hamlet Onwer or Owners of Property ADELE COSENZ0 .......... County Tax Map No 1000, Section .... ~ ........ Block .... ~ .......... Lot .... 28 ............ Subdivision .................................... Filed Map ............ Lot .................. Permit No... ~}~ ...... Date Of Permit~Z~QQQ ........ Applicant..NAILIE. ONGIONIX~-ATTY--- Health Dept. Approval .......................... Underwriters Approval ..................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... · 25 OO Fee Submitted: $ ' liIRIg ONGIONI APPLICANT FOI~I NO. ~l TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF' OCCUPANCY No ..... Z..][.~ ......... Date ........................... De.l~o~e.~.....~.0. ,, 19~... THIS CERTIFIES that the building located at ...~.~;...N~[',ZO~,~..~Oa~. ............................ Street hing W~ter Mo~p~l ...................... ~lock No ........ ~ ........ Lot NOl ..~J~ ......... ~Oat~o~!.t..~T..~Z. ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. · D~g~e~,,,,.~.O ...... , 19.~]i.. pursuant to which Building Permit No. doted .......................... Dee* ........ 20 ........, 19~..., was issued, and conforms to (;~ c~the requirements of the applicable provisions of~f~eO~a~w. The occupancy for Which this certificate is issued is ........ ....... ~r.i~a~e .. m~e...£a~t.l¥...d~e;L1 ~a~ .......................................................................................... The certificate is issued to . .~heede~e....[wa~ln.~,~' ...................0wae~. ......................................... (owner, lessee or tenant) of the aforesaid building. ,NO H,D.Approval Building InsRector INSPECTION [ ] FOUNDATION l ST [ ] ROUGH PL [ ] FOUNDATION2ND [ ]INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE N N 84' 21' E 110.00' 45. ~' ~ ~coNc.24.8, stoop N 84'21'E CONC. 1S TORY I DRIVEWAY WOOD ~ 14 FRAME co~c~., coNc, 45. 0 ~ ~ TM1000-078-05-28 ~ ~SCREENED AREA AREA= 12,650 SF. ~ ~/ o~ CM , S 84' 21' W 110.00' TM 1000-078-05-29 AREA= 15, 750 SF. 110.00' S 84' 21' W 110.00' N/F LUBOV TM 1000-078-03-28 & TM 1000-078-0Z-29 Guarantees indicated here on shall rut~ only to the person for whom the survey is prepared~ and on his behalf to the Ir~ ThO cs~;cnees of the lendi,~g bstltufion. GUARANTEED TO JASON TAGGERT FIOELITY NATIONAL TITLE INS. CO. NORTH FORK BANK TOWN OF SOUTHOLD SURVEY OF DESCRIBED PROPERTY S/TUATE SOU THOLD, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR JASON TAGGERT Unauthorized alteratbn or addition to this survey is a vblation of Section 7209 of the New York State Education Law, (~op~'es"bf t~nls survey map not bearing the Land Surveyors embossed seal shall ~ot be considered lo be ~ valid tr~ copy. SURVEYED 2~ DECEMBER, 1999 SCALE AREA/ZOTAL) : 2¢400 SF 0.606 ACRES( TOTAL N N/F CARLSEN N 84' 21 E 110.00' ~ ~. N 84'21'E ~roop 45.1' CONG. STOOP 45.0' WOOD FRAM~ RES. TM 1000-07~ AREA= 12,650 CM S 84' 21' W 110.00' N/F LUBOV WELL El CESSPOOL LOCATION #ROVIDEO BY OTHERS WALL SHED W/ OVERHANG TM 1000-078-0~-29 AREA= 1.7, 750 SF. S 84' 21' W TM 1000-078-03-28 TM 1000-078-03-29 SURVEY OF DESCRIBED PROPERTY SITUATE SOU THOL D, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 110.00' only fo th~ person for whom fh~ ~ve~ is prq~c'rcd, grid on his b~hd{ to the title ccJs~; c'~', Cover,. enid Agency, to lbo cs.,:qnees of ~h,: Io~kllng bsfiMbn. SURVEYED FOR JASON TAGGERT . flauthor[~ed alteration or addition to ,. r~s*/ k t~ vMafion of Section 7209 of the New York State Education GUARANTEED TO JASON TAGGERT FIDELITY NADONAL TITLE INS. 00. NORTH FORK BANK TOPIN OF SOUTHOLD Copies of thls survey map not bearing the Land Surveyors embossed seal shall nat be considered to be a valid tru~ copy. I, ADD WELL& CESSPOOL LO~ 9FE$ O0 SURVEYED 29 DECEMBER, 1999 SCALE 1%40' AREAX~OTAL) = 26,400 SF ~606 ACRES( TOTAL ) FO~,]~I NO. 1 TOWN OF SOOTHOLO EP^eT ENT TOWN CLE,,'S O.,CE SOUT.O,D, N. ¥. ........................... ,~......Perm~t No....~ ......... , ......... Drsapproved ~ ~~ .... Z.~ ....... ~'~ ~ ~'-~ ..~: ,' .............. ' ........ ~.~'~'~;~"i~;~;)"O .......... ~ ~ .......... APPLICATION FOR BUILDING PERMIT Dote ........ ~.~..C ....... ~:~ .................. , ~..~i~ ....... INSTRUCTIONS o. 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 odioining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Buitding Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the .applicant. Such permit shall 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 po rt for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Buitding Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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 oil applicable taws, ordinances 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 premises .'..~'~'".~...C):~....~.~...~........~..Zc/~d..x~...~.'.z~../..x(~/..' ............................................................ 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' . ................... ~ - ~ ./.-/~¢.~ bf..Z/'-/ Street and Number z~/,,:~.x~.(/..~..2, x/..,s..../c...4, z?../~ ................................ . ......... .-f.~../.9. ......... /..~ ............................... 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 :.~....~..~..'.~..z~.,2/.,~ .g/.'.....~.. ~ .~..~....Z::... ff ./.x../. ~ .................. 3~ Nature of work (check which applicable): New Building ..,.;..1~,., ........ Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4, Estimated Cost ................. :~f)...~ ................................ Fee ........ ............................................................................... ii~ be paid on filing this application) 5. If dwelling, number of dwelli6g units ..........~ ................ Number of dwelling units on each floor ............................ If garage, number of cars ...! ................ ~ .................................................................................................................... 6. If business, commercial or imixed occupancy, specify nature.end extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth .............................. Height ............................ NUmber of Stories ............................................................................................................. Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of enhre new construchon: Rear Depth Height ........ .~,,~ ............. Number of Stories ....... ~ ....................... 9. Size of lot: Front ....d'.../..:}.,...; ............. Rear ...... ././.~. ............. Depth ........................................ 10. Date of Purchase ..?....r.:..~...j..../.'.,..~'....~:.,~ ..................... Name of Former Owner ~J/ 11. Zone or use district in whiih premises are situated ....... .~/~..~.~..'.~..../...D.....~..~...~/....?...(..~2.....~=. ...................................... 12, Does proposed construction iviolate a:ny zoning la, w, ordinance or regulation? ..... ./- 13. Name of Owner of premise~,..~.~.°..:.Z~..kY/J.,~.AC/./?Address ,.:.4.~..~..f(...Z~.:~..?..,.Z.'....~. .......... Phone No, Name of Architect ..............J ....................................... Address ............................................ Phone No ..................... Name of Contractor .<~..'F'Zt'.,~..~....C/...r...S..r.$'/X/..~.~s.~ZAddress ........ Phone No.~..r?, >..i~.~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and blo~k numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y~Ri/>~'_,, /_ ) COUNTY OF ../,¢~¢~.-~.) S!.S., .......................................................... ~ ........................................... ~ duly sworn, deposes and says that he is the applicant (Name of individual signing 'application) above named. He is the .~.f4.L..&~..~.~ ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui9 authorized to perform or have performed the said work and to make and file th~s ~pphcat,on; that all statement~ c~qt~ ~.t~pplicat.on are true to the best of his knowledge and belief; and tho~ Sworn to ........... ...... ..... ....... , _ :1 . .: ~~.... ~ .~.~ ................... 'u.. ............................. ~.:: .......................... o o,y of TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Perm t No ............. Disapproved a/c ........ ................... ................................... . (Building In.speftor) APPLICATION FOR BUILDING PERMIT Date ,Z~)~-zz c' ~ ~c~ 19..~..~.. ....... 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 p remises, 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 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 progress of the work. e. No building shall be occupied or used in whole or in pa rt 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 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 premises . ~..~:~....~...f?.~....~.~..-~...... ~../Z~..Z~...~'.~'f.Z./.~/.?. ......................................................................... If,applicant is a corporate, signature of duly authorized officer. I. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number,~.z~.~.~//./~').Z.~.~.../~.~..¥2 .z~../_~ ... ~.~. ~Z~f ~..~/~ ~Z~ ~ Municipality ' "~/~'~'~/°"~'"~"~ ~)'V"' "' '"""" '" ~'"' '"' 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 .:~...~2~2.ZZ..;~.....~..~..~.~z..~..Z../b(..~ ........................................... 3. Nature of work (check which[ applicable): New Building ....~ ....... Addition .................. Alteration ................... Repair .................... Removal~ Demolition .................... Other Work (Describe) 4. Estimated Cost ................... ~) ....................................... ee .......................................................................................... ,' (to be paid on filing this application) 5. If dwelling, number of dwellinlg units .............................. Number of dwelling units on each floor ............................ If garage, number of cars ...... ] ............... ~... ................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structlures, Jf any: Front .......................... Rear .......................... Depth .............................. Height ............................ Number of Stories ............................................................................................................. Dimensions of same structur~ with alterations or additions: Front ................................ Rear ................................ Depth ............................ Hei~lht ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front.......':~......?, ................ Rear .~ ...................Depth ........................... Height ........ ./.. ................ Nurpber of Stones ......~ ....................... /' , 9. Size of lot: Front ..,.~. ............ t ............ Rear ...... ./..Z'..~. ............. Depth ........................................ 10. Date of Purchase ~'~?~' /.2~.., (..~ Name of Former Owner ..~'~.....,~.....~./...~.../.(....~...?......~.. ............ 11. Zone or use district in which premises ore situated ....... .~...~...'~..../.'.?,...~....,:(~......~T,.....~.....~.2.....~=.. ...................................... 12. Does proposed construction 9iolate any zoning la,w, ordinance or regulation? Y' O 13. Name of Owner of premises~...~.~.°..:.,d~,../~..,~..~../.V..,/./.~'Address ....~'...~....u., ..~.../~...~.L.~....~. .......... Phone No..~... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~...,~'.~?;~'....-~.....(~..c, fk'~/...~.Z~-~.Address ...,-~..~...q....7~...~ff..~....Z:....~,. ........ Phone No.~....c?.~T,~.¢...~.. (' PLOT DIAGRAM Locate clearly and distinctly al buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. G ve street and block numbers or description according to deed, and show street names end indicate whether interior or corner lot. STATE OF NEW y6ORI/-~_,,/z ) COUNTY OF ~) S.~,~ ................................................................................................. ~ duly sworn, deposes and says that he is the applicant (Nome of individual signi~ ] 'application) above named. He is the . .~...~../.....~'....Z?....~.....~. ........................................................................................ (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:contoir~;~T~lnZ.tt~t(~pplication are true to the best of his knowledge and belief; and that the work will be performed i~?Ul~e~s~f~, ~e.~e~oV~ in the application filed therew th. ........... ...~....~.~,. do~,of ............. ~...~., 19... ~.~.. ,~,~. c~,~~~ Notary Public .... ~~'~" '""'~~'i ~C nt (S.gnature of applicant) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ ..L?.. ~. ~ Approved ........................................ , 19,...!...Permit No. ¢~ ~z, '~ Tn/ ~_~ Disapproved a/c .................................................................................. .................. .................................... (Building Insp~fctor) APPLICATION FOR ~BUILDING PERMIT Date ............ ~..~..~........~?....~ .................... , 19.~i.,.~·. ...... 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 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 application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approvol of this application, the Building Inspector will issue e Building Permit to the applicant. Such permit shall 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 pa rt 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 demczlition, as herein described. The applicant agrees to comply with all applicable laws, ordinances 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, pbmber or builder. ,. ........................... .......................................... ..................................................................................... Name of owner of premises ......7~....,?~....~..'~.~.).~..~..rf~...z~.......~....k~..../..~.~.~.../.~../..../.~ .................................................................... If applicant is a corporate, signature of duly authorized officer. .......... (Name and title of corporate officer)'-- ,z 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number ....~..~.../,~..~.../~.../....~.....z~...O.~....~.. ....... .~..Z~I...M..¢~:~/.../Z~....~......fM/~...Z*.,C..'Z~..~~. ...... ~.~..~...~...~.../~..¢?..~....~., 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 ..... ./.......~....-K~./.."Z.... ~.. 3. Nature of work (check which applicable): New Building ....... ~... Addition .................. Alteration .................. Repair .................... RemovalI .................... DemolJtlon .................... Other Work (Describe) ........................ 4. Estimated Cost ............:)'""i ....................................... Lee .......................................................................................... (to be paid on filing this application) .............................. Number of dwelling units on each floor ............................ 5. If dwelling, number of dwelling units / If garage, number of cars ~ 6. If business, commercial or imixed occupancy, specify nature.and extent of each type of use ................................ ,ve ' , Front ....... ......... Rear. ............ 7. Dimensions of ~g~struc~ures, if any: ......................... Depth Height ...../...~......f. ........... 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 ................................ Rear ............................ Depth ............................ Height ............................ Nur%ber of Stories .................................. 9. Size of lot: Front ........./../..~Z../. ......... Rear ....... /.../..6]./. ......... Depth ... Z/ 0 ~ 10. Date of Purchase ..... ~....~..~.;x.../...~..~..~ ................... Name of Former Owner .~.~...'..~.~..~./T../...~.....~.. ............. 11. Zone or use district in which premises are s tuated ......... · .~....z~..~]./..?.....ZT].A.~/....7]...~..~....~.....~::~... ............ 12. Does proposed construction yiolate any zoning law, ordinance or regulation~ ..... /f/..O. ........................................ 13. Name of Owner of premises~.~...E]~'/~..~"~ w~. ............................../~ Address ............. ~'~ ~ '~.~ .......... z, .~.. ........... Phone No..~ ..... Name of Architect ............... i ....................................... Address ............................................ Phone No ..................... Name of Contractor .~..~.(~...~./~, Z¢ .Z./. ¢ /c'Z:'/$5'4'/FAddress 3 ~ c~ ..Z~.//.. ~ L /'~ Phone No.~..~..~].'7.,;~.~.,)./'. PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and blo~k numbers or description according to deed, and show street names and indicate whether interior or corner lot. ~ t STATE OF NEW Y~OR]~, ./2 )i' coup** S. ...................... · .......... z....~.......~.~ .......... : ...................................... ~emg duly sworn, deposes and says that he is the applicant (Na,me of individual signing application) above named. He is the ....~..~.,~.;~.,~.~...f.~...: ................................................................................................................ j (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this ~pplication; that all statements[,e~a~ this application are true to the best of his knowledge and belief; and that the work w be performed ' H~t~rY~t forth in the app ca~ on f ed therew th. Sworn to bef re me th~s , ~ dayof ~~ , 1~ ~ ' ~ / ' ........................ ~ ........ .; ~ ~ '"~' ..... . ........ ~.~ Notary Pubhc, ...~.~.~...~~~~ (S~gnature of applicant) OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF oCCUPANCY ~OI~.OWI ..... 0 ~.~M FO~ THE FOUNDATIoN "~ f~$PECTIOHs: - TWO REQUJ ~- HOUGH. F~M ~""'" ~ INSU~TION G & ~ FINAL . CONSTRUCTiO ..~ECOMPLETEFORcn N MUST ~ CONSTRUCTiO~ · ~E REQUIRE-~,,~ On~LL MEET '"'=~/a OF THE N ~ STATE CONSTRUc~ ...... CODEs. NOT RES~uN & ENERGy DESIGN O C~u~- PONS/BLE FOR R --"ofRUCTION ERRORS UNDERWRITE~ CERTIFICATE .