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Home My WebLink About24489-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26174 Date: 12/17/98 THIS CERTIFIES that the building ADDITION ALTERATION Location of Property: 80 WEST DR SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 58 Block 2 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 6, 1997 pursuant to which Building Permit No. 24489-Z dated NOVEMBER 14, 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 ADDITION TO EXISTING ONE FAMILY DWELLING TO INCLUDE A DECK AND GARAGE EXPANSION AS APPLIED FOR. The certificate is issued to ERNEST SCHROEDER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N451997 04/28/98 PLUMBERS CERTIFICATION DATED N/A Building Ins ctor Rev. 1/81 FORM NO.S 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) NOVEMBER 14 97 24489 z Date................................I............................. 19........... Permission Is hereby granted to: ENVIROMENT EAST INC. .......................................................................................... P.O. BOX 190 ..................................................................................... PECONIC,NY 11958 ............................................................ CONSTRUCT AN ADDITION TO AN EXISTING SINGLE FAMILY DWELLING to.............................................. ............................................................I............. .............................. TO INCLUDE A DECK AND GARAGE EXSPANSION AS APPLIED FOR .................................................................................................................................................................. ..........................I.......t............................................................................................................................... ................................. . .......................... ............................................................................................... .................................................................................................................................................................. 80 WEST DR SOUTHOLD atpremises located at............................................................................................................................... ................................................................................................................................................................ 473889 058 0002 016 County Tax Map No. .......................... Section ........................ Block ........................ Lot No. ........................ OCTOBER 6 97 pursuant to application dated .......................................................... 19................ and approved by the Building Inspector. 75.00 Fee$........ ............ ............. .. .:/B�u4lldlng� ............................... pector Rev. 6/30/80 � I DEC I C I998 FORM NO.6 BLDG pEpr TOWN OF SOUTHOLD t TO Wfr FSo rrf�OLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted s® 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 features. 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. 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 informa- tion required to prepare a certificate.` C. Fees: 1. Certificate of occupancy $25 . 00 -- BUSINESS $50. 00 ACCESSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50 . 00 3. Copy of certificate of occupancy $ 45 . 00 , over 5 years $ 10 . 00 .Vacant Land C.O. / S.Updated C.O. $ 50 . 00 Date New Cons tructiori , , , , , , Old or Pre-existing Building . . . . . . . . . . Vacant Land . . . . . . . , Location of Property . . . . . . . . . . . . . . Y. , at . . . . . . . . House No. Street Hamlet Owner or Owners of Property z�m*AT. . ,c�,� c-�i A. _ County Tax Map No. 1000 Section . . . .C �r , , , Block . , . , , Lot . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . ... . . Filed Ma Permit No; : !. ! .&�' . . Date of Permit 1• l %�' Applicantt',,-'. �� `� i!�� Z,u�'. FOA Labor Dept. Approval , , , . . . . . . . . . . . . .Health Dept. Approval Underwriters Approval . . �� ', , , . . . . . . ,Planning Board Approval . . ' , , Request for Temporary q p Y Certificate . . . . . . . . . . . . . . . . . . . .Final Certificate Fee Submitted $ . . Sq.r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Construction on above described buildi n e II icable codes and regulations. Ap . . . . . . . . . . . . . . . . . . . . . . . . . . . Rev. 10-10-78 I' JUDITH T. TERRY . r�� 'Q?-- �' Town Hall, 53095 Main Road TOWN CLERK '. P.O. Box 1 179 r tt� 4f Southold, New York 11971 REGISTRAR OF VITAL STATISTICS Fax (516) 765-1923 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER ;�Or :° j1b Telephone (5 16) 765-1801 FREEDOM OF INFORMATION OFFICER 1 T OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93)] , and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)] . D � TOWN OF S0J7H0LD G��j`—�f---'� Judith T. Terry Southold Town Clerk August 25, 1993 r ' APPLICATION # PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1• GENERAL PROVISIONS (APPLICANT to read and sign): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. 1,THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, T B OF MY KNOWLEDGE, TRUE AND ACCU TE. a., (APPLICANT'S SIGNATU E DATE SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANT) NAME ADDRESS TELEPHONE APPLICANT BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) _ 4L APPLICATION # PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) ❑ Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofmg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- ❑ Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT $ B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ Other (Please Specify) After completing SECTION 2,APPLICANT should submit form to Local Administrator for review. SECTION 3: FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ❑ Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4• ADDITIONAL INFORMATION REQUIRED(To be competed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: ❑ A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development plans,drawn to scale,and specifications,including where applicable:details for anchoring structures,proposed elevation of lowest floor(including basement), types of water resistant materials used below the fust floor,details of floodproofing of utilities located below the fust floor and details of enclosures below the first floor. Also, ❑Subdivision or other development plans(If the subdivision or other development exceeds 50 lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofng protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in Any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. ❑ Is B. ❑ Is not in conformance with provisions of Local Law # , 19 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # PAGE 4OF4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved? ❑ Yes ❑ No Conditions SECTION 6: AS-BUILT ELEVATIONS To be submitted by APPLICANT before Certificate of Compliance is issued) The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofing protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑EXISTING BUILDING ❑ VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_ SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: C/C(93) THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1001093 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 Date APRIL 28,1998 Application No. on file 15321098/98 N 451997 THIS CERTIFIES THAT f;'. ' only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of MR. E. SCHROEDER, 80 WEST DRIVE, SOUTHOLD, NY in the following location; ❑ Basement ® lst FL ❑ 2nd Fl. GAR Section Block Lot 15 was examined on APRIL 22,1998 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENTI FLUORESCENT I OTHER AMT. K.W. AMT. I K.W. AMT. K.W. AMT. K.W. AMT. H.P. 4 10 4 4 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OSYSTUTLET TET DIMMERS !!T! OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V I C E METER NO.OF CC COND. A.W.G. A.W.G. A.W.G. AMT. AMP. TYPE EQUIP. 1 0 2W 1 0 3W 3 0 3W 3 1D 4W PER 0 OF CC.GOND. NO.OF HI-LEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL 1 OTHER APPARATUS: PADDLE FAN-1 G.F.C.Ir-1 DOROSKI ELEC. INC. LIC.#2941- L 425 MONSELL LANE CUTCHOGUE, NY, 11935 GENERAL MANAGER 11 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. BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] R GM PLBG. [ ] F NDATION 2ND [ INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: D,� DATE 2 3 S� INSPECTORS 2 �rN8�� BUILDING oar. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] F DATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: 001 DATE INSPECTOR �� ,oz suauiNc oar. INSPECTION [Y] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE �� INSPECTOR v M-1102 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ j ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS ON [ ] FRAMING 14 FINAL [ ] FIREPLACE & CFIIMNEY REMARKS: 94i '> Imo DA� /% INSPECTOR �J�� M-102 UILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN AITION [ ] FRAMING FINAL [ ] FIREPLACE fLCHIMNEY REMARKS: 7T LX DATE �� INSP f � , 10 ��r.. MOW�ffl Al ISI imi MOOM VMMIO! WER • � I-I ISI � �l tee''_ZWIM + Ill � ISI �l 1 FORM NO. 1 • TOWN OF SOUTHOLD BUILDING DEPARTMENT lt,.a TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 00, rY Examined . . . . !�!✓./. 19�� . . . . . . . . . . ,519 . . Received Approved " Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /FOR ( pector) APPLICATIOUILDING PERMIT Date 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 dfawn on the diagram which Is part of this appli- 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 permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws,Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . .�� . .��: . . . .eon.1-t'.Fth-c�R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . , , ,S Cl &•0.�u5K -�. . . . . . . . . . . . . . . . . . . . • • . (as on the tax roll'or latest deed) If ppli- s •r a ' s' i+rre of duly authorized officer. (Name and title of corporate officer) Builder's License No. . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . .CQ R,0 ,O F 'jr0� �, Ljrt�,c •• , ,�R °_ _ . . . . . . . . . . . . _ f�-kw45D._... . tr-�— �-�. .. . . . . . . . . . . . . .. House Number Street Hamlet os� County Tax Map No. 1000 Section . . . . . .J.. . . . . . . . . . Block . . . . . . . . . . . . . . . . Lot . . . . . Subdivision . . . . . . . . . . . . . . . .(Name) Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . S•�•' �? . . . . . 0.mr�c ty c�W¢ �t✓�. . . . . . . . b. Intended use and occupancy .JLC . l�. . . . . . . . . .t. . . . l�l� 4t. • . • • • • • -�¢ �. `e ot e cA. 0. 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . .0 . . . . . . . /, (Description) 4. Estimated Cost . 41eox-G.G.C) .�. . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. If dwelling, number of dwelling units . . . . .N L. . . . . . Number of dwelling unfiih$ach floor . . . . N: Ifgarage, number of cars •. . . . . . . . . . . . . . . . . . . . . . . . . . . :. . 6. if business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front Rear .(?. . . . . Depth . . . . Height Number of Stories . . . 112r. . . . . . . . . . . . . . . . .�; . . . . . Dimensions of same stfucture with alterations or additions: Front ( Ae ��.�sq n4�: . Rear .(?� ��.t.'Pe.1 Depth . . . . . .571.b.`. . . . . . . . . . Height . . . ?�"¢. , Su�. . . Number of Stories . . .112 . . .15,4? . . 8. Dimensions of entire�qew construction: Front . . . . . `f . . . . . Rear . . . .1.1. . . . . . . . . Depth . . . �::. . . .. . . . Height . . . . Zl .'O . : . . . Number of Stories1.. . . . . . . . . .!5-b . 9. Size of lot: Front . . . . .I.�b•.�.c( . . . . . . . . Rear . . . . . . .>.:5P _71.. . . . . . Depth . . . . . . .: .7.`1... . . . . . . . 0. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nape of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Zone or use district in which premises are situated . . . . . . -J'0 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'.r 2. Does proposed construction .vi late any zoning law, ordinance or regulation: . . . . . !".�:. . . . . . . . . . . . . . . . . . . . . . 3. Will lot be regraded . . . . . .Ii 0 . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes + 4, .Name of Owner of premises RPJAs.C S4 kt49�?(-;PERAddress A W tAT. A K-. . . . . Phone No. .7.1a S •.-Architect . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . Phone No. . . :;,::��G of Contractor U: �T;,!NC.- , , , , , Address .! v:-A `. . 4 Q': :'Ph6he NU .3 A. 7.4 Z • f'EC owcc- � . PLOT DIAGRAM t, Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether iterior or corner lot. TATE OF5N OR . . e—S.S DU F . �. `,E being duly sworn,deposes and says that he is the applicant (Name of individual signing contr t) ,ove named. isthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . (Contractor,a t, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file4this plication; that all statements contained in this application are true to the best of his knowledge and belief;and that,the -rk will be performed in the manner set forth in the application filed therewith. .orn to before met is - ; . . . . itary Publi . . . . . . my M (Signature of applicant) - _ t - wN• - t _ 1• •r _ ^T •i' 'I cr 44 12- X 381 Ist��a.'j ,. . , .___ -LtrlC OF Ll IL ;�: _ L-_ - ► s-'� �o' __ i.:.: SUrRVE`fED FOR LU CV ` "' Nv •,'� — ', o� , SITUATE AT i ;�- SOV t POL_ D ? o �51 — -�--.::r! { I� t�� o•y -t o cece �; _ .. -� .l {3L'J 1•! 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