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Home My WebLink About26037-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27643 Date: 04/27/01 THIS CERTIFIES that the building ALTERATION Location of Property: 725 ROSEWOOD DR MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 113 Block 2 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 19, 1999 pursuant to which Building Permit No. 26037-Z dated OCTOBER 19, 1999 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 FINISH EXISTING ROOM (DORMER) IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GREGORY & KATHLEEN SCHOLAND (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ H-024666 09/25/9 PLUMBERS CERTIFICATION DATED N/A uthg ized Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26037 Z Date OCTOBER 19, 1999 Permission is hereby granted to: GREGORY & KATHLEEN SCHOLAND PO BOX 1255 MATTITUCK,NY 11952 for FINISH EXISTING ROOM (DORMER) IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS BUILDING PERMIT REPLACES BP#23418-Z. at premises located at 725 ROSEWOOD DR MATTITUCK County Tax Map No. 473889 Section 113 Block 0002 Lot No. 008 pursuant to• application dated OCTOBER 19 1999 and approved by the Building Inspector. Fee $ 75 .00 Aut riz Sig ature ORIGINAL Rev. 2/19/98 C` Form No. 6 Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR,CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of .property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that �he 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 a 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, /Commerciiajll $15.0O Date . . . . ✓:lJ.' q( . . . . i. . .Y.:.: / . . . . . . . . . . . . . . New Construction. . . . . . . . . . Old Or Pre-existing. Building. . . . . . . . . �//J Location of Property. . . 7r)J� , , , , , , ,, , , , , , , , C GL� x�D p'.?!{lZ. . . . . . . . . .lRJ'k -.7. �!G'fe House No. /� Street Hamlet Onwer or Owners of Property.. . ./. . *'L! z!� . . . . . . . . . .. . . . . . .�G'!7t�C.. ... . . . . . . . . . County Tax Map No 1000, Section. . . .�1�?. . . . .Block. . . . . .C2.. . . . .Lot. . . . . .45, . . . . . . . . . . . . . Subdivision. . w u 77 . . sl./t-J S. . . . . . . .Filed Map. 2 . .Lot. . . . . . . . . . . . . . . . . . . . . . - IFPermit No. . ��3. ZDate Of Permit. . . . �Cl.�.. ... Applicant. . . . . i�? �. . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Cer``tificate. . . . . . . . . . . Final 7Ce,/ta 'Fee Submitted: $. . . . . . .'l. .Y/ . . . . . . . . . . . . eNK. 59360 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L 0 _a7� u 3 APPLICANT o��gUFfO(,�COO, o� y� Town Hall,53095 Main Road to Z Fax(631) 765-1823 P.O. Box 1179 O Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD April 9 , 2001 GREGORY & KATHLEEN SCHOLAND P.O. BOX 1255 MATTITUCK, N.Y. 11952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file . XX The check is (not on file. ) $25 . 00 No Health Department Approval on file . No final inspection has been made . No Plumber Solder Certificate on file . (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 26037-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. THE NEW YORK BOARD OF FIRE UNDERWRITERS ►�A<;." 2,7648 BUREAU OF ELECTRICITY ' 85 JOHN STREET, NEW YORK, NEW YORK 10038 S.hN1'rtImil0* 25 199;, .i 33a0ja0 H 0),4x)66 Date ` A%icption No.on ffije THIS CERTIFIES THAT f 'RM..I.'C. �• �.�i%�S PrP d, only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of KATH[II:RN & G.SCHN,ANT), 725 IWSEWi')OD TWTVC, MArT'VNICK, N.k in thefollowinglocation; ❑ Basement ❑ 1st Fl. [?� 2nd Fl. Section Block Lot uws examined on . '( fiT;R 1. °1'� 1. and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES 1COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTAClES SWITCHES INCANDESCENTI FLUORESCENT I OTHER AMT. I K.W. AMT. I K.W. AMT. K.W. AMT. K.W. AMT. H.P. i DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PTj TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DSS OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS AMT. WATTS - NO.OF FEET SERVICE DISCONNECT NO.OF S E R V I C E AMT, AMP. TYPE METER I e'2W I,g SW 3 AV 3W 3 p IW NO.OF CC.COND. A.W.G. NO.OF HI-LEG A.W.G. NO.OF NEUTRALS A.W.G. EQUIP• PER 0 OF CC.COND. OF HIAEG OF NEUTRAL = OTHER APPARATUS: i GREGORY SCHCA.AND S ' 725 ROSEW( 01) DR. MA"CTI7110',., NY, 11952 ORMAL MANAGER Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. i i a< �3 "!u tN�CERAfIG �y i 3i ICUPANCY OR 3 E IS UNLAWFUL "HOUT CERTIFICATE ICCUPANCY s AiPROIFED AS NOTED DATE: b B.P.N.C.IL76— Lal- NOTIFY BUoo G 016AS;2NT AT 766-1802 9 AM TO 4 PM FOR THE I/A FOLLOWING INSPECTIONS: F i. FOUNDATION - TWORMU1RED FOR POURED CONCRETE Jlrt/`i�(/G 1 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET K 11t THE REQUIREMENTS OF THE N.Y. 1 it STATE CONSTRUCTION & ENERGY `010- )(7m - a COOS. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS OUST. ORDER NO. L. K.Comstock I>Company, Inc. JOB LKC JOB NO. DESCRIPTION Electrical Construction DR.BY DATE CHKD. I REV. SK. NO. FORM 7240A CUST I low -v(hL) IORDERNO. L. K.Comstock E Company, Inc. JOB LKC JOB NO. Electrical Construction i-)ESCRIPTION — OR.BY DATE CHKD. I REV. SK. NO. •f u H t.1 7240A � o�o�OSOFFO(�-coGy� N = Town Hall, 53095 Main Road 0 • Fax (516)765-1823 New 9 ��Ol � Telephone(516) 765-1802 Southold, Nw York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD March 15, 1996 Mr. Gregory Scholand P.O. Box 1255 725 Rosewood Drive Mattituck, NY 11952 Re: Building Permit #18768-Z - (alt. to finish dormer) Premises : 725 Rosewood Drive, Mattituck Suff. Co. Tax Map #1000-113-2-8 During a review of our files it was noted that the above building permit has expired, and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold, Article XXVIII 100-284 , it is unlawful to occupy or use a structure until a Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. �o�oSUFFo�,�oo G Print Key y� Page 1 5738SS1 V2R3M0 931217 w 7 D 03/15/96 09 : 34 : 4C Town Hall, 53095 Main Road p • Fax (516) 765-1823 DispladN e.wYork.11 . `1!'e �� Telephone(516) 765-1802 U§t*o NYSRPS ASSESSMENT INQUIRY DATE 3/15/9e 473889 SOUTHOLD SCHOOL MATTITUCK SCHOOL ROLL SEC TAXABLE PRCLS 1 FAMILY RES TOTAL RES SITE 113 . -2-8 OFFICE OF THE BUILDING INSPECTOR TOTAL COM SITE 725 ROSEWOOD DR TOWN OF SOUTHOLD ACCT NO 14 OWNER & MAILING INFO ===I=MISC l======== ====== ASSESSMENT DATA SCHOLAND GREGORY & !RS-SS ! **CURRENT** RES PERCENT KATHLEEN ! 1 !LAND 1, 000 **TAXABLE** PO BOX 1255 ! BANK !TOTAL 6,500 COUNTY 6,5C 725 ROSEWOOD DR TA02848 **PRIOR** TOWN 6,5C MATTITUCK NY 11952 ! !LAND 1, 000 SCHOOL 6 ,5C I !TOTAL 6,500 ==DIMENSIONS =__ l=====_= SALES INFORMATION ACRES .46 !BOOK 10501 SALE DATE 00/00/00 !PAGE 00563 PR OWNER =======TOTAL EXEMPTIONS 0 _____________!_= TOTAL SPECIAL DISTRICTS 4 CODE AMOUNT PCT INIT TERM VLG HC OWN CODE UNITS PCT TYPE VALUE IFDO30 1PK071 IWWo20 lSWO11 F1=NEXT PARCEL F3=NEXT EXEMPT/SPEC F4=PREV EXEMPT/SPEC 75. 10- 03-013 F6=G0 TO INVENTORY F9=G0 TO XREF F10=G0 TO MENU 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) Date..............�Y..8.T................................... 19.9.o...... N2 23418 Z Permission Is hereby granted to: GREGORY 6 KATHLEEN SCHOLAND ....................... ...................I....................... .... P:O. BOR...1255. . . .... ..-„7„ 25ROSEWOOD„PA!".............. . ........ . . . . .. MATTITUCR, NY 11952 .......................................................................................... to .....FINISH E%I STING ROOM (DORMER) OF A ONE FAMILY DWELLING AS APPLIED FOR. ......................................................................................................................................................... ................................................................................................................................................................ ................................................................................................................................................................ ...I......I....................................................................................................................................................... .................................................................................................................................................................. at premises located at......725„ROSEWOOD..DRIVI ,...................?LIT. :. %................NR....................... ................................................................................................................................................................ County Tax Map No. 1000 Section ......!.13............. Block........................ Lot No. .............8............. pursuant to application dated .................J.ANUARY...16..................... 19.... 0......., and approved by the . . .......... Building Inspector. Fee$....... 75.00 THIS PERMIT REPLACES BP# 18768-Z. Bu, i ...................... n n1sp Rev. 6/30/80 >r r FORM x0. f 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) N218768 Z Date ...x,12 ........................................ 19.E Permission is hereby granted to: .......... sf ............................... ............rte, ` , �2ep(:...... zV,5'-z—pp to mo i .. "••CTS [.L ...'za- ....., -rx7. r .- ........... ..c ....... ............................QQ............................... of premises located at .....ZA17. ..... ,R G�1 �...................I............................ ............................................................�f2r/.. ............................................................... ............................................................................................................................................GG................... County Tax Map No. 1000 Section ........1/3.... Block .........2...... Lot No. ..... .............. pursuant to application dated ...........//z1r,........ ........................ 19W. ,., and approved by the Building Inspector. 4ee" Fee ..................... ng I for Rev. 6/30/80 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND LINSULATION [ ) FRAMING [ ] FINAL REMARKS: CJLo ,t . DATE O INSPECTOR �v 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN JLATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE ®� INSPECTO [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSIJkAT10N [ ] FRAMING [ FINAL [ ] FIREPLACE& CHIMNEY REMARKS; DATE INSPECTOR 7e- M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 LATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: C T� 7,4, DATE J v INSPECTOR m 3 H 83 FOUNDATION FOUNDATION ( 1st) a - Z FOUNDATION ( 2nd ) _ 2 . 0 0 ROUGH FRAME & -PLUMBING cn 3 . m m IIISULATIOi! PER N. Y. a �. STATE ENERGY CODE Wc S 4 . \ y FINAL ADDITIONAL C0:4MEHT m v m ' � x H I a • H H v O • m a r H \ m H D BOARD OF HEALTH . . • . � 3 SETS OF PLANS '� . . .PLANSFORro NO. 1 SURVEY . . yy� .IMS UM TOWN OF SOUTHOLD CHECK . - V. . .# 3.r0.r'I. . . . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . . . TOWN HALL B' PT. SOUTHOLD, N.Y. 11071 NOTIFY ': 1OWNOFSOUTNOLD q TEL.: 7G5-1802 CALL Examined . . . . . . ... . . . . . .. 19 /. b MAIL T0. . . . . . . . . . . . . . . . . Approved . . .15. . . . . . . ., 19 .?OPcrmit No./. , 7th . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . wilding Inspector) APPLtCATIGN FOR BUILDING PERMIT � / . Dat;. . . .tw . . . ., 1S1` INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wit! sets of plans,accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre: or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issued a Building Permit to the applicant. Such perp 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 Occu.-mm shall hive been g,-a;,-cd by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other plicable ws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for re at a liti , as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building s' o , and regulations, and i admit authorized inspectors on premises and in building for necessary inspect' (Signatu� 'applicant, or name, if a corporation) •fir. (0753" .�r�'�-n,.��l. .�'L'.`Z. . . /./.S.f.L . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde UN . . . . . . . . . . . . . . . . . . Name of owner of premisesi? c�2y . PJ`'( 1! �8'`f!�. . . r ( !r! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. ...Q @"....... . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . OtherTradc's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be dere' . . .?d! S ' . . . . . . . . . . . . . . . .1.n . s� . . . . . . . . . . . . . . . . 1.� ?!c./� . . . . . . . . . . . . . House Numbcr Street. Hamlet County Tax Map No. 000 Section . . . . . / k. . . . . .Blv J Lot . .6.. . Subdivision . . . . . . . . . . . . . . . Filed 1 lap No. � 7!, „ Lot . . . . . . . . . . . . (Nene) State existing use and occupancy of premises and intended use and occupancy of roposed construction: a. Existing use and occupancy . . . . . . . . . . .. ... . . . . . . . . . . . . b.Intended use and occupancy . . . . . . . . . .(' !! . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . .Swi-11 ap0��01, . . . . Tennis Court . . . . . . Accessory Building. . . . . . . . . . Fence . . . . . . .Otr1cK. '.' . 1 ;" 4. Estimated Cost . . . . . . . . o�p off . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... . . . . (to be paid on filing this application) • ......4 5. If dwelling, number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . , Ifgarage. number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy,specify nature and extent of each type of use . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . . , -k'. -A': . . . Rear . ... .��.: :. . . . Depth . . . . . . . . . Hei:ltt . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . .4� . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . ./f!<. . . . . . . . Rear . . . . . (q-3. . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. l^. to of Purchase . . , . lyB?-. . . . . . . . 12 /� ee✓eS2 . . . . . . . . . . . NameofFormer Owner . . . . . l . . . . . . . . . . . . . . . . . . . . . . . 11. Zon(,. or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning Iaw, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13, Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . .Will excess fill be removed from premises: • Yes . .. . No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . .. . . . . . . . .Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . .,. . . . 15 .Is this property located within 100 feet of a tidal wetland? *YES . . . .NO . .. *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. , STATE OF NEW YORE, S.S COUNTY OF . . . . . . . . . . � �s }} . .V . . . . . . . . . being duly sworn, deposes and says that he is the applicai (Name of irfdividual signing contract) above named. A �' He is the . . . . . . . . :N(�i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed tate said work and to make and file th application; that all statements contained in this application are true to the best of his knowledge and belief; and that ti work will be performed in the manner set forth in the application filed therewith. Swam to before me this . . . . . . . . . . .dayof. . . t . . . . . . .. 19�b "'X Notary Public, , , 'County lio-a MMR11NN � / . . . . . . . (Signature of applica, 1YnmA�N'M.hIf1�1 i