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Home My WebLink About24427-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25338 Date OCTOBER 27, 1997 THIS CERTIFIES that the building ALTERATION Location of Property 945 FLEETWOOD ROAD CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 137 Block 4 Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 30, 1997 pursuant to which Building Permit No. 24427-Z dated OCTOBER 24, 1997 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 REMOVE EXISTING NON-CONFORMING TIN GARAGE & REBUILD WITH A WOOD GARAGE "AS BUILT" & AS PER ZBA #4515. The certificate is issued to TIMOTHY McNALLY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building In--LFL-;tor 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) Date......OCTOBER 23.......................... 19...97... 24427 .. ......... Permission is hereby granted to; TIMOTHY MCNALLY ........................................... .............................................. 945 FLEETWOOD ROAD .......................................................................................... CUTCHOGUE,NY 11935 ............I..........................r................. .............................. to......REMOVE AN EXISTING NONCONFORMING TIN GARAGE AND REBUILD WITH A . .............................................................................................................................................. WOOD GARAGE AS PER Z .B.A.APPEAL#4515 10-9-97A" a . ....... ......................................................... ................................................. ........... ........ .......I................. ........ . ..................................... .. ................................ , ........ . . ........... .................. ....................................................................................................................... ... .......................................................................................... ...................................... .............................. at premises located at....................9.4.5 FLEETWOOD RD CUTCHOGUE .............................................................................. .......................................................................... County Tax Map No. ......473889.... Section ....137........... Block ......0004....... Lot No. .023.............. pursuant to application dated .....JULY................30......................, 19.......97.... and approved by the Building Inspector. Fee$.........35.00 ��.1..../- . Building Inspect Rev. 6/30/80 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 the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. . B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and 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 OcCupa-itcy - ew dwelling $25.00, Additions to dwelling $25.00, Iterations to dwelling j$ O Swinuning pool $25.00, Accessory building $25.00, d_Zt1 t3'on��o�Z2�sst5P"y-bu31. ng $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - .25m. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . �I3iI4.� . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . ./. . . Old Or Pre-existing Building. . . . . . . . . . Location of Property. .gp5:t5y5. Flee 7oGD. Po. . . . . . -E . . .No- Yl9—. . . . . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . �.l!`!�C�h��. . .P .f ( �'.. ' ^� /3-7 County Tax Map No 1000, Section. .-}4r'"R?. . . . . . .Block. . 7. . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No A y vq 7 9 t_. . .Date Of Permit.1 0-,Z3 I9 . . .Applicant. . " . . . . . : . . . . . . . . . . . . Health Dept. Approval.. . . .Underwriters A roval`I . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Cer.tificate. . . . . . . . . . . Final C zcate. . . . . . . . . . Fee Submitted . $ . . . .�S. . . . . . . . . . . . . . . . j . . . . . . APPLICANT. . . . . . . . . . . . . . . . . . . . . . . . CIO � a5 338 rrttiRt Mrl '1 '1"f)WNOi° .iOtl'1'tlCl(.I) - il(.Itf_1)IN(: 1)t i'Alt'i',l((,N'f' -1-mm Ci.,[iZK"$ Ul-t-1CT: SUI►"i"i101..t7. N.t'. W)TICE OF MSAPPROVAI, tate �. . ` 10 . .-.f"71!%: ... . . . . . . . . PLEAS11 TAMs NOTICE Ilial ynnr :,hitlicatin,t flalefl . . . . , . , • � 19 � 7 ror hermit to 1 i_ocatiprr ti( C'rnherl y !. . . / �!✓d4G� 7 � Co /�oqs! Nn• 1�� C01111l,v !'ax N4111Mcg. 1 UOQ Scct it)n . . . . . . . . . . . . . . Block . . . .�4. . . . . . . . Lot a7 . . . . . . . . $irlrtlivisiprr . . . . . . . . . . . . . . . . . rifetl Nlah r%lt..l. . . . . . . . . . . . . . . . . Lot Na. is rclurrtctl here^.riih ant) tlis:rt+innvrtl nn Ihr rnlln-ing Irromiffs . .r. . . . . � � . . . . . . . . . . .�..r . . . . . . . . . . . . All- • � .�'? . . . . . . . a. `o _.:cam: . . . . _ . �,;� . _ . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • . • • . . _ _ . . _` . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . t3ui. 1 ding Insper-(*- 17V ect•izv l /fIn o�OS�FFO��c O Town Hall, 53095 Main Road y = Fax (516)765-1823 P. 0. Box 1179 Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD ORDER TO REMEDY VIOLATION Date: July 30, 1997 TO: Mr. Timothy McNally 25 Mill Creek Rd. Port Jefferson, N.Y. 11777 PLEASE TAKE NOTICE there exists a violation of : Zoning Ordinance - CHAPTER 45 Other Applicable Laws, Ordinances or Regulations 45-8 at premises hereinafter described in that: A DECK ADDITION HAS BEEN CONSTRUCTED ON A DWELLING WITHOUT A BUILDING PERMIT, ALSO A METAL GARAGE HAS BEEN REPLACED WITH A NEW WOOD STRUCTURE WITHOUT A BUILDING PERMIT. In violation of CHAPTER 45-8 YOU ARE THEREFORE DIRECTED AND ORDERED TO comply with the law and remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at: 945 FLEETWOOD RD. , CUTCHOGUE, N.Y. SUFFOLK COUNTY TAX MAP #1000-137-4-23 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may con 1 ute an offense punishable by fine or imprisonment or both. J N M. BOUPIS LDING INSPECTOR encl . (Cert. Mail) rrintil 11411 '1 II1.111.1)IM(: I)I.1'n lt'I'1\I l:f 11' rc)lvrl (:[,[:I?r:'s (,1-.171 : 50111110 .n. WY. 1`IU'1'ICL Ur 1)1SAI'I'It0N'A1, 4&14k,.. . . . . . . . . 7� 1'L S s TAKF NOTICE Illni i pmr nl,llicnom, l:►Icrl . . . . . Ip 1 for I l(:1'111 I I Irl /e�'?%''�^""!`�;�. J ,�,�•''•�`. . . . . . . . . . . .'�l! Locntir)n of Properly . . (, � �t!./�� . .�� /bIn,mof /Va. $Irrtn.f ./larrrin,I 1 C0441)ly '1':Ix 64111 11,1o. 1000 Sccli(,)n d . . . . . . . . . . Lllock . . . . . I �. . . . . . . . . Sobdivisioll . . . . . . . . . . . . . . . . . Filed 11 --ill M(.r. . . . . . . Lot No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix r .Inrnrtl Ilcrewill) ,11141(tl�ic�lrl/ttivr11/oil Ilrc roII otviII llrt)n IIIc/0- 47 L�� Xxl � - . . ,4 . . . . . Oe t - 13►t)..Irlinq In ecl:�l: 12v l /Rn r SFFOI/rcoG may► y� Town Hall, 53095 Main Road y Fax (516)765-1823 P. O. Box 1179 Telephone(516)765-1802 Southold, New York 11971 • OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD ?"'01) TO: Zoning Board of Appeals FROM: John M. Boufis, Building Inspector DATE: October 10, 1997 SUBJECT: Suff. Co. Tax Map #1000-137-4-23 T. McNally, Owner In response to memo on the status of a Certificate of Occupancy, or Pre-Co. for the accessory guest cottage and the main dwelling on the above premises, the main dwelling is eligible for a Pre-CO and the accessory cottage would be ok for a Pre-CO since it has never lost it use. The only problem that arose was the deck addition on the accessory cottage. When this matter is resolved, a Pre CO can be issued for this accessory cottage. Also a CO can be issued for Building Permit #11188-Z for alterations to the accessory cottage that was issued by George Fisher, at the time, Sr. Building Inspector. APPEALS BOARD MEMBERS SUFFO��► 0�4 CD Southold Town Hall Gerard P. Goehringer,Chairman �`t` Gym 53095 Main Road Serge Doyenti P.O. Box 1179 James Dinizio,Jr. • Southold, New York 11971 y Fax(516)765-1823 Lydia A.Tortora 0,( �a0 Telephone (516) 765-1809 BOARD OF APPEALS D TOWN OF SOUTHOLD OCT 8 07 INTERNAL TOWN-DEPARTMENTAL MEMO 2 TO: John Boufis, Building Inspector FROM: ZBA Office DATE: October 7, 1997 SUBJECT: 1000-137-4-23 T. McNally We have researched our files to determine the history of the applicant's property which contains two dwellings on one lot, and have not found any ZBA actions. Also, we were not able to locate any CO or Pre-CO. Would you please confirm whether the owner has applied for a Pre-C.O. or a C.O. for both dwellings, and if the deck were to be removed, would the CO or Pre-CO be issued? This would assist the Board in determining the history of the property before it makes a determination on the deck (which deck appears to have been built years after the buildings were constructed) . The public hearing on this application is calendared for tomorrow, October 9, 1997, and the application could be carried over to another meeting, pending a determination by the Building Inspector as to eligibility for a Pre-CO or CO. Thank you. APPEALS BOARD MEMBERS S�FFOj,f- J �0 C� Southold Town Hall Gerard P. Goehringer,Chairmani�� Gy 53095 Main Road Serge Doyen N '` P.O. Box 1179 G • Southold. New York 11971 y Fax(516) 765-1823 dia A.Tortora Telephone(516) 765-1809 OCT 15 'f BOARD OF APPEALS BLDG.DEPT. TOWN OF SOUTHOLD T WN OF.SOMQW FINDINGS, DELIBERATIONS AND DETERMINATION REGULAR MEETING OF OCTOBER 9, 1997 Appl. No. 4515 - TIMOTHY McNALLY PARCEL 1000-137-4-23 STREET & LOCALITY: 945 Fleetwood Road, Cutchogue DATE OF PUBLIC HEARING: October 9, 1997 FINDINGS OF FACT f PROPERTY FACTS/DESCRIPTION: This property is located in an R-40 Low-Density Residential Zone District, being situate on the north side of Fleetwood Road, Cutchogue. This lot contains a total area of approximately 12,500 sq. f t. and. its boundaries are more particularly shown on a survey map dated October 24, 1994 prepared for Timothy McNally by Rod- erick VanTuyl, P.C. The subject premises is improved with two one-story frame buildings (single-family uses), an "as built" garage and an "as built" deck, both of which are the subject of this application. BASIS OF APPEAL: Building Inspector's two Actions of Disapproval (a) dated August 8, 1997 which reads as follows: " . . .under Article XXIV, Section 100-242B, the nonconforming old tin garage with a conforming use {has been replaced with a new wood structure) shall not be rebuilt or repaired if it has been damaged by fire or other causes to the extent more than 50% of its value, until the building is made to conform to the required height and yard requirements. . . ," and (b) dated September 8, 1997 which reads as follows: " . . .under Article XIV, Section 100-243A a nonconforming building with a nonconforming use shall not be altered, enlarged or structurally reconstructed unless such building is changed to a conforming use. . . . J Page 2 - October 9, 1997 ` Appl. #45r5: 1000-137-4-23 (McNally) Southold Town Board of Appeals ARCA VARIANCE RELIEF REQUESTED BY APPLICANT: (1) For approval of "as built" 10' x 18' accessory garage building with a setback at a variable between 4 inches (shown on the survey map) , or four feet maximum setback (measured by applicant) from the side property line, and (2) for approval of "as built" open deck construction as an addition to nonconforming dwelling, an extension of this building which contains a (second) dwelling use on this lot. Deck construction is shown to be not larger than 20' by 20' as sketched on the survey map, and accessory garage is shown to be 10 ft. wide by 18 feet, for a total height of 10 ft. REASONS FOR BOARD ACTION, DESCRIBED BELOW: The Town Building Inspector has confirmed accessory cottage is eligible for a Pre-Existing Certificate of Occupancy. (Note: The application has been on file with the Building Department for issuance, pending the outcome of the garage and deck variances) . (1) The granting of the area variance will not produce an undesirable change in character of neighborhood or a detriment to nearby properties because the "as built" deck has been attached to this accessory cottage for at least 18 years and is approximately 20 feet (more or less) at its closest point to a natural revetment (stone) barrier between rear of property and wetland area. (2) The benefit sought by the applicant cannot be achieved by some method, feasible for applicant to pursue, other than an area variance because of the uniqueness of said parcel with one principal dwelling and one seasonal accessory cottage, and 10' x 18' nonconforming accessory storage building. (3) The requested area variance is not substantial because as stated above attached deck has been in place for at least 18 years prior to code restriction, and for a longer period of time for the 10' x 18' accessory storage building which was in poor condition and has been reconstructed. (4) The proposed variance will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because variance requested is for an attached open deck as built which has remained unenclosed since its existence and reconstruction (10' x 181) of a nonconforming storage building in place, in kind, at a variable between 4" and 4 feet from the west property line; and no encroachment whatsoever. (5) The situation has been self-created. Page 3 - October 9, 1997 Appl. #4515: ' 1000-137-4-23 (McNally) Southold Town Board of Appeals (6) This action is the minimum that the Board deems necessary and adequate and at the same time preserves and protects the character of the neighborhood, and the health, safety, welfare of the community. RESOLUTION/ACTION: On motion by Chairman Goehringer, seconded by Member Dinizio, it was RESOLVED, to GRANT the relief as applied and SUBJECT TO THE FOLLOWING CONDITIONS: 1 . "As built" deck construction shall remain as built and not be enclosed into a porch or other type of room; 2. "As built" deck shall remain unroofed. 3. "As built" garage shall not be enlarged in any manner. 4. "As built" garage shall not be used or converted for sleeping quarters or any use other than accessory storage or garage purposes. 5. Re-construction of this garage by 50% or more will require moving the garage to conform with a three ft. minimum setback from the side property line and at least 21 feet from the front property line along Fleetwood Road. VOTE OF THE BOARD: AYES: MEMBERS GOEHRINGER, DINIZIO and TORTORA. This resolution was duly_�dopted. (Member Doyen of Fishers Island was absent. ) GERARD P. GOEI3RINICER, C IRMAN RESOLUTION ADOPTED Actions.all/137-4-23 1 thl.11 1II'il'lil:f 1MIT Il�P4 llll-IIIy�T�n» I�Inllnlnrlun ( Ir'1') —•7i t vi .. ... ,.�n nsn---------------It �— •...+..+..•,r,+--�-...-r+.-...••nnrr+.+-�•..�+.........ws.a..r�•r w.n-•w•nn+++s�..�n nn• I 1`l.11l 111 I H(; \ r +•.+....w----w---•w-nnw--.--- •drn�•n.�w•n nnnn rt-----..------n.-•---.----- ---- ------------------------ 11. ..-----------------warm.11. Y . STATR NII°I111Y (:1)111: 1'I Ilnl. ^^^^ Alll)tT l OIIA1. COf itll;it•111 1 '.^•^•..nn...w�..wnnn�w.wnw.�n�.w--------.+.....•..,----n.-------- -----.n•m -..--------------------- �J w 0 • o t•- r•` u I� — I BOARD OF HEALTH . . . . . . . . . . . . . . . " FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . Q _; ;!? BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . `� _" �.t SOUTHOLD, N.Y. 11971 T�`�h/IaaOhSCr; ,,ry TEL: 765-1802 NOTIFY: CALL . . . - - -�� 7� fo Examined.. d�:3 19.... MAIL TO: . . . . . . . . . . . . . . . . . . . . Apprrn►ed.,r�0. '.. / 19.... ....... .................................... Dia/c .` .��. .... .................................... f .. . . -(Bu• ing Inspector) APPLIC ION FOR BUILDING PERMIT Date. . . .. . . . . . .. 19. 7 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 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 cammenced 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 throa>glmt 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 HERBY MALE 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 Ordinances-or Regulations, for due construction of buildings, additions or alterations, or for r d ition, as herein described. The applicant agrees to comply with all applicable laws, ordi ildi , housing code, and regulations, and to admit authorized inspectors on premises and in ung for nec inspections. Ale .. gnatuae of applicant, or name, if a corporation) L w',,\ L 90 (Mailing address of applicant-If* 1t Tl-7 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................... `. • LL-4 tt Name of owner of premises .....�LL .. .. .. ":'�........ .................. �-tMo;E;�- l�( �...........��1► A c A 1��'Rb1f�Q��NOTED (as on the tax Toll or latest deed) If applicant is a DATE:----------B.P�# app corporation, signature of duly authorized officer. F EE-' BY- ......................................................... NOTIFY BUILDING DEPARTMENT AT (Name and title of corporate officer) 78-5-1802 B AM TO 4 P6V1 FOR THE FOLLOWING INSPECTION& 6. FOUNDATION - TWO REQUIRED Builders License No. ......................... FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING Plumbers License No. .,NRULATION Electricians License No. ..................... CONSTRUCTION IM13ST BECOMPLETE FOP41 .O. Other Trade's License No. .................... ALL CONSTRUCTI�iSHALL. MET 7"" REOUIREMENTS 1. Location of land on which proposed work will be done............. - ... ..........'" �.Ct�IVST'Ftl1C1'ION�8a ENI<Rf�a�t' .....`�o ..:�..�! 5.... (ze uvooc ...J2.`.Q::......C,�f_c i'oCUe , `r1 NO'11 t F%85 4O BIBLE FOR House Number Street � d x(5149 JGTOW FiFt(3Ha Canty Tax Map No. 1000 Section 1.37.4..4 3. Block ........!....... Lot .....a'.b...... Subdivision ..... �e ets N �.�............ 131. . Filed Map No. .......... .... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. "("- e.......................................................... b. Intended use and occupancy ....... ....:......................................................... 3. Hature of work (check whidh applicable): New t3uilding .......... Addition .. ,Alteration .......... Repair ............ Removal ............. Damlition ............ Other Work J4 aC'EF .............. (Description) 4. Estimated Cost fee .............................................. (to be paid on filing this application) S. 11 &P-al l ing, anther of dwelling units ............ tkAwr of ckiel l ing units on each floor ................. TF garage, [anther of cars . 'r=".rDle ....... ............. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.... ............. 7. Dimensions of existing structures, if any: Front:�P.0x94?.... Rear ............... Depth ................. *Y� Ileiglht ... T.................. Number of Stories ...................... Ni ' Dimensions of same structure with alterations or Additions: Front ............... Depth .................... Height ....................h: Umber of Storieht ............... B. Dimensiot k. A entire new construction: Front. ................ Rear ............... Depth .............. Height ......................... Nnther of Stories ..................... 9. Size of lot: Front .. :"f .......... Rear .... ........... Depth .. �..�: �P.... 10. Date of Purchase ...9q9 � ............ Name of Former Owner ..30� ... 95�Jl0e.,................ II. Zone or use district in whidh premises are situated .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...:................... 13. Will lot be regraded .....,,.n........... Will exces fill be removed from : n ,YES (2 Iii. Names of Owner of premises .1 r '':1: klress Q0 �t�hV4AR:. .Sne No Name of Architect .......... ......................... Address .............................. Phone No. .............. Nameof Contractor ................................... Address ..... ............,...........Phone No. .............. 15. Is this property within 300 feet of a tidal wetland? NIP......... NO .......... *1F YES, SOLMKID MM =RHES PERMIT MAY BE W!,QMRM. PI.O'r DIAGRAM Locate clearly and distinctly all buildings, wetiher existing or proposed, and indicate all set-back dimensi hons from property lines. Give street and block number or description according to deed, and show street names and indicate wi hedwr interior or corner lot. Se-eC - isfi1�S SI IE OF NU YO(?K SS OLINlY (V .:5 C( J;CS I jK• - - T,wo :�e�,,,,/�// -04-0 -14.1° .........................being duly sworn, deposes and says that be is the applicant (Name of individual signing c tract) above named, Ileis the ....... .........A/M......................................................................... (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 appticatirnh; that all. statements contained in this application are true to the best of his knowledge and belief; aml that the work will be perfonnecl in the m neer set forth in the application filed therewith. Sworn to before me this .............:'.Q....day of U ..19..x,1.?.. Notary Public J! ...... ., P" (S' mr hcant) York