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Home My WebLink About24212-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26683 Date: 09/13/99 THIS CERTIFIES that the building NEW DWELLING MATTITUCK Location of Property: 250 SOUND BEACH DR (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 99 Block i Lot 16 Subdivision Filed Map No. Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 20, 1997 pursuant to which Building Permit No. 24212-Z dated JUNE 23, 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 ONE FAMILY DWELLING WITH COVERED FRONT PORCH, DECK AND ATTACHED TWO CAR GARAGB UNDER AS APPLIED FOR. ZBA #4452. The certificate is issued to RICHARD A. & CHRISTINE RIVERA ( O~ER ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-96-0023 ELECTRICAL CERTIFICATE NO. 21336 PLUMBERS ~ERTIFICATION DATED 05/17/99 CHRISTINE RIVERA 09/02/99 11/25/99 Rev. 1/81 lrO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIl- FULL COMPLETION OF THE WORK AUTHORIZED) N.° 24212 Z Permission is hereby granted to: &~,~. ~.~~...~.~,~,~ ................ .~.~....~./../.~y.......~ .......................... ,l~ ~. . . ~ . . . ,~. . . ./.~. . . . . . ~. ../. . . . z~ Z~ . . . ~ ';,. ~. . . . .,/. . . ~. . . . . . ~ ............ ~ ~.~,.. . . . . .f. z. ,:.. . . /. . .z Lz~.~:. ~ /. .~ ~.z/oe. . e. . .s. . . /. . ,. . . .. . .~~. . . l~.....~ ~.....4~.:..~....Y~..~.:......~Z/.~/..zT.~ ................. ._. ....................... ~ ................................... . ..... at prem,ses located at ........................... · .~..~/-~...../~.~...~-.......~,.....~..~..< ....... Court,-, Tax Map ,,,o ,000 S,~t,on ....Z~ ............ '~'~'~ .... .<2../.. ......... 'at ','o...Z~ ........... pursuant to application dated ..,...~.~/~,,....~,. .......................... , 19..~.Z and approved by the Building Inspector. Fee $ ..................... ~.~ Rev. 6/30/80 DATE: 11/25/98 ELECTRICAL INSPECTION SERVICE INC. $ 75 D UNTON A VENUE EAST PATCHOG UE, NEW YORK I1772 (516) 286-6642 21336 A PPlff CA TIOH 31o. ON FILE FILLAGE: ll/Iattit~lck , ADDRESS: _250 gound Beach Drive ISSUED TO: Chris Richard Rivara INTRODUCF. D BY.: Aztec Elect~qc Sou&old LICNo: 4173E 11/25/98 and found to be in compliance wtth the Nattonal Electrical Code LOCATION: Base.. 1st 102 Der Garage Hot Tub 2nd 3rd Amc SWITCHES RECEPTACLES FIXTURES HE~TERS FANS I lOG'.EL AiR COND: 60 62 76 2-exhaust DISHWA~'HER DRYER CLOTHES WASH, GAR. DISP. RANGE OVEN SMOKE DETECTOR 1.2 kw 30Amp. 20Amp. 6 FURNACE OIL GAS CIR. MOTORff BELL TBAN. SER~CE DISCONNECT 1 2000H OTHER EQUIPMENT Outside, Res. 7-paddle, 3~1/2 hp garage door opener, 1-microwave 20Amp. 1-whirlpool 20Amp., 1-steam generator 30Amp., · ..... 1-200 Amp. sub panel, 1-200Amp. disconnect, 1-hood 2-a.c. compressors 40Amp. each 2-air handlers 20Amp. each HUGO S. SURD! P~$IDENT B UIL DING PERMIT No. ~ oertifloat* must nc~ be altered m aay maVner TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application 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 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 build/ 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings a Vpre-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 . i. 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-existinK Buildinm - $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 New Construction ........... Old,Or Pre-existing Building ........... . ...... ~ C p y ..................... ~. ......... ~..;...~ ........... ~ ...... ~ ........... . House~ ' Street Hamlet . ow es of ropert/..!i ........ ..... .Cf ..... ............... . .......... County Uap Uo 000, Section... ....... Block ...... Subdivision .................. . ~ ................ _ ~ Filed Map ............ Lot .............. . . . . Permit No ............... Date Of Permit ......... Applicant..~..u~..~1,~ .~ .......... Health Dept, Approval....... ............ .. .. ... Underwriters Approval........ ......... .. .. Planning Board Approval . . . Request for: Temporary Certificate ........... Final Certicate. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Permit No. °~YJ/2 ~ 7__- (please print) Plumber: (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this Notary Public, /~, ~ County HELENE D. HORNE Notaly Public, State of New York NO. 49.51364 Corn Qualified in Suffolk County .... mission Exp res May 22, 19 ~._.~ APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Serge Doyen James Dinizio, Jr. Robert A. Villa Lydia A, Tortora BOARD OF APPEALS TOWN OF SOUTHOLD Southold Town Hall 53095 Main Road P.O. Box I 179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765- 1809 FINDINGS, DELIBERATIONS AND DETERMINATION ADOPTED AT REGULAR MEETING OF MARCH , 1997 ADD1. No. 4452 - CHRISTINE RIVERA PARCEL ID: 1000-99-1-16 STREET & LOCALITY: 250 Sound Beach Drive, along along the westerly side of Inlet Drive, Mattituck, NY DATES OF PUBLIC HEARINGS: Feb 6, 1997, Feb. 25, 1997, and March 13, 1997 ' RELIEF REQUESTED BY APPLICANT: AREA VARIANCE: On December 17, 1996 original request was to construct new dwelling addition and alteration; however, recent amendment of ZBA application as per survey dated March 11, 1997 applicant is e ' r questing the location of new dwelling construction (rather than only an addition and alteration) due to recent advice She has obtained from Building Inspector(s) required Flood Management Laws for construction over 50% of value for this flood zone. This new d,w. elling construction is proposed at the miD/mum required 15 ft. sldeyard from the westerly property line, and proposed 34.5 ft. front yard setback from the edge of steps to Sound Beach Road. and 34 feet from Inlet Drive (a dead end street). ' PROPERTY DESCRIPTION: This property is located in an R-40 Residential Zone District, being situate on the westerly side of Inlet Drive, and the northerly side of Sound Beach Drive, with frontage of 157.33 feet along a tie line along mean highwater mark of the Long Island Sound (Dec. 21, 1996). The size of the total lot area of this parcel is shown to be 39,996 on the March 11, 1997 survey, and is presently improved with a one-story ranch dwelling (single-family). BASIS OF APPEAL: .January 14, 1997 Building Inspector's Action of Disapproval, which reads as follows: under Article III-A, Section 100-30A.3, "...proposed construction will have insufficient front yard setback for an R-40 Zone. With revised survey showing total property area as 39,996 sq. ft., 40 ft. setback is required .... REASONS FOR BOARD ACTION~ DESCRIBED BELOW: 1. The granting of the area variance will not produce an undesirable change in character of neighborhood or a detriment to nearby properties because: a) Flood Management (FEMA) Law requires further elevation of dwelling and size of house will create a "tunnel" effect; Page 2 - Appl. #4452 Re: Christine Rivera Decision Rendered March 13, 1997 b) if applicant were required to meet code setbacks, the alternate would be to construct closer towards the Long Island Sound (flood area), which is also not desirable to adjoining property; c) alternative would establish a different "line of vision"; d) all the same reasons given by applicant at the publio hearings are hereby reiterated as if re-written in its entirety; e) this is the first dwelling wnich is required to be elevated at a height of 9 ft. from ground (and 10'5" first floor etev.), with reconstruction value over 50% of the existing house; f) as a corner lot, the easterly yard is deemed by the town zoning provisions to b~ a front yard rather than a side yard, when tiffs would be defined side yard on an interior lot. g) the impact is minimized by the g-rant of alternative relief. 2. Board Member(s) find that the relief as alternatively granted is not substantial because houses in the area have similar setbacks (the house across the street has a 9~0 ft. front yard). 3. The proposed variance will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: a) the new construction is an upgrade over the existing construction under the FEMA (flood law) reg~dations. b) setbacks on the westerly side are increased from 15 ft. to 20 ft.; c) to the east is acreage owned by operated by the Park District which buffers the subject property and the setbacks; d) not to grant otherwise could have extended the house closer towards the high water mark; 4. A majority of the board members ~ind that the practical difficulties are self-created. 5. This is the minimum variance necessary under the circumstances, and the health, safety, and welfare of the community %viii not be adversely affected by this location, is built in accordance with all laws and as alternatively granted herein. I~ESOLUTION/ACTION: On motion by Chairman Goehringer, seconded by Member Dinizio, it was RESOLVED, TO GRANT the following alternative relief: 1. Minimum setback from Inlet Drive shall be 29 feet to the property line; 2. Minimum setback from the westerly property line shall be 20 ft. which is the It-40 Setback requirement for lots 40,000 sq. ft. and over, Page 3 - Appl..i4452 Re: Christine Rivera Decision Rendered March 13, 1997 3. Minimum setback for proposed steps area from Sound Beach Drive shall be 34'5", as requested. 4. Any mechanical systems or structures shall be located on the easterly side of the house (or underneath). VOTE OF THE BOARD: AYES: Members Goehringer, Doyen, Dinizio, Villa and Tortora. This resolution was duly adopted. Approved for filin~ Also reviewed by ~4'"'Y), ~];~]q7 [:oOF,,~' Actions. zb / 991-16 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD May 11, 1999 Richard & Christine Rivera 22 WillettS Court Rockville Centre, NY 11570 To Whom This May Concern: We are unable to complete your Certificate because of XX XX XX XX the following reasons: of Occupancy An application for Certificg~e of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (not on file.)$25.00 No Health Department Approval on No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 24212-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. I'-i,<UM ~Ir-.V~-N MARE$CA ~16 ?'28 9J.8'~ Steven L. Maresca ! . Consulting Engineer 88 - 07 West. Montauk Highway FIampton Bays, New York 516 - 728 - 9480 Fax 516 - 728 - 9484 DATE: January 19, 1998 TIME: TO: Phil FAX'#: 212-779-4136 RE: Rivera Residence Number of pages including cover sheet: Message As per your request I have run the calculations for the timber header over the north wall of the main Living Room window. The following was noted. It appears that you have specified the use of pre-manufactured timber trusses for the main roof. Cross-section 9 on sheet A-12 shows a rough outline of this truss. The Living Room has a cathedral area which causes the main reaction of the truss to be taken by the interior wall of the building rather than the northern exterior wall. I have based my calculations on this assumption. The northern end of the truss should have a reaction of approximately 360 pounds per truss or 180. plf of wall. You should have this reaction checked with your truss fabricator. You should also specify the installation of a hurricane clip for each truss or rafter to the wall plate. Check: with the truss fabricator for uplift. With these assumptions I have sized a header of 3 - 13/4# x 11 7/8" LVL. This header should be bolted together with two ~" bolts at 12" o/c. The header should be supported with triple jack posts at each end, set on top of tripled floor joists, . ~ ~(~) Call if you have any questions, Albert I, Krupski, President 3vhn Holzapf01, Vice President Martin H. Garrell Peter Wenczel Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) ~/65-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 7, 1997 Christine Rivera 258 Sound Beach Dr. Mattituck, _~Y 11952 RE: SCTM 999-t-16 Dear Ms. Rivera: The above referenced property was reviewed. As per the site plan dated 3/4/96, the proposed renovations are out of the Trustees Jurisdiction. This dose not constitute any approvals from any other agency. If you have further questions, please do not hesitate to Contact this office. Sincerely, President, Board of· Trustees AJK:jmd cc: Bldg. Depto~' New Yor~ State Depaub,,erd; of E~vironme~ii~d Cortservation Bui/di~g 40. SUNY, Stony B~ool~ New York 11790-2356 Telephone (516) ~. 0365 Facsimi/e (516) ~.~.~. 0373 Mr. Richard Rivera 250 South Beach Drive Mattituck, NY 11952 Date: April 11, 1996 Re: 1-4738-01297/00001 Rivera Property SCTM 1000-99-1-16 Dear Mr. Rivera: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that: the property landward of the ten foot elevation contour as shown on the survey prepared by John T. Metzger dated January 9, 1995 and revised for topography on December 28, 1995 is beyond the jurisdiction of Article 25 Tidal Wetlands. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. -Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, Deputy Regional Permit Administrator cc: Pasquale J. Castellano BMHP File STEVEN L. MARESCA CONSULTING ENGINEER 188-07 W. MOlX~AUK HIGHWAY · HAMPTOlq BAYS, NY 11946 · (516) 728-9480 · FAX (516) 728-9484 December 12, 1997 James H. Rambo Construction Inc. Bishops Lane Southampton,, N.Y, 11968 Re: Pile Certification Rivera Residence Sound Beach Drive. Mattituck, N,Y, Dear Mr, Samuels: This letter is to certify that I am a Professional Engineer and have reviewed the timber pile foundation for the project as referenced. The timber piling have been driven to grade in accordance with Code Requirements, Timber piling ( Southern Yellow Pine ) have been treated in accordance with A,W,P,A, C3 Foundation with 1.0# retention (min,), The piling have been installed in accordance with standards of good practice for this area, Timber girders and braces are CCA treated. All hardware was hot dipped galvanized. This review was intended to check the method and materials for pile installation and _pi_l~e_~apaci~ty.~ ~W~e have not chec_k~d fo[ _f_gundatioP location. Please advise if any further information will aired. Since , ate~sca I~'. E. COUNTY OF SUFFOLK ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES MARY E. HIBBERD. M.D.. M.P.H. COMMISSIONER PERMIT THE ATTACHED PLAN, WHEN DULY SIGNED BY A REPRESENTATIVE ~OF THE DEPAP~TMENT, CONSTITUTES A PERMIT TO CONSTRUCT A WATER SUPPLY AND/OR A SEWAGE DISPOSAL SYSTEM FOR THE PROPERTY AS DEPICTED~ CONSTRUCTION MUST CONFORM WITH-APPLICABLE STANDARDS INCLUDING THE STANDARDS FOR CONSTRUCTION ,'OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES AND STANDARDS AND PROCEDURES FOR PRIVATE WATER SYSTEMS. THE PERMIT (PLAN) EXPIRES THREE (3) yEARS-AFTER THE APPROVAL DATE. ANY MODIFICATIONS WHICH MAY AFFECT THE PROPOSED SEWAGE DISPOSAL SYSTEM OR WATER SUPPLY REQUIRE SUBMISSION oF A REVISED PLAN AND ANY , ADDITIONAL FEES, 'PRIOR TO CONSTRUCTIQN. NO INSPECTIONS WILL BE · PERFORMED BYTHE DEPARTMENT ON EXPIRED PERMITS. PERMITS MAY BE REISSUED UPON THE 'sUBMISSI°N OF NECESSARY 'AppLIcATIONS, PLANS AND FEES, AND WILL BE ~E ,, QUIRED TO MEETfTHE STANDARDS IN ·EFFECT AT THE TIME OF REiSSUANcE---i ' · : · OF ~ REQUIREDTRANSPER FEESf' IN:THIS CASE~ THE 'PARTY PAYING THE oRIGINAL APPLICATION FEE WILL ;BE coNsIDERED TO BE ,THE ORIGINAL Ii WWM- 058 RVERHEAD N.Y. JI9~1-3~97 PAGE 1,OF2,, INSTRUCTIONS'i 'OR FINAL APPROVAL OF CONSTRUCTED SYSTEMS ....... call the Department to arrange inspections of the sewage disposal system ~md ~'ate~ These include inspections of the soil excavation for the sewage disposal system ' ~,ell, well lateral, public water supply line, disposal system, piping and fit½al -.quired. md inspections: The applicant must submit 4 prJ uts of an as-built plan (up to and including 1 l"x17"), by a licensed design professional, of the subject pro[' erty showing the following: a. the lot location and dhnensioOs; b. the lot nmnber(s) and the nmne of the subdivision, if applicable; c. penrtanent structures (i.e., bu ldings, driveways, walkways, swimming pools, decks, etc.); d. the exact location of the priv ~te well, if applicable (give at least 2 dimensions measured from the comers of the building); e. the exact location of the pub! ic water line, if applicable; f. the exact location of the sept: c tank and leaching pool(s), if applicable. Give 2 dhnensions from the building comers to the covers of the se] tic tank and each leac. hing pool; g. the exact location of the sew j r line from the dwelhng to the street; if applicable; and h. have a clear area at least 3' ~x5" for the Department's approval stamp. The applicant must submit a ce rtificate from the sewage disposal installer attesting that the system has been installed according to the criteria of the Suffolk County Department of Health Services, when applicable., If a well has been installed as the potable water supply, the applicant must submit a current well water analysis (within one year) and a well dr~ler's certificate. If the well or water quality does not c.onfonn to standard's, proof of corrective measures will be [equired. Refer to "Standards and Procedures for Private Water Systems." In those cases where public servers are utilized for the dwelling, the applicant is also to submit one (1) copy of the sewer line inspection approval from the public sewer district. In districts operated by Suffolk County, two (2) copies of Form S-9, duly execrated by the Suffolk County Department of Public Works, are required. It is the applicant's responsibility to supply facilities prior to backfilling. and hlspections of the water supply' grading. Other inspections may be Following satisfactory constmctlon In those cases in which tile ins! the Department of Health Serv HEALTH BE ON ALL C( allation and connection of the public water service line has not been inspected by ecs, a tap letter from the appropriate water company is required. DEPARTMENT REFERENCE NUMBER MUST ~RRESPONDENCE OR DOCUMENTS SUBMITTED. SUBMIT ALL qECESSARY FINAL PAPERS AT THE SAME TIME. PHOTOCOPIES OF DOCUMENTS WILL NOT BE ACCEPTED. WWM-058 PAGE 2 OF 2 18-380_12/92 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ]/,~DUGH PLBG. [ ] FOUNDATION 2ND [,~] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: . ~.~:~*~ ~ DATE . INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I~ISULATION [ ] FRAMING [~/] FINAL [ ] FIREPLACE & CHIMNEY RE~ ,,,s,.,CTO,, 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ~OuGH PLBG. [ ] F~OUNDATION 2ND [ ] INSULATION [ ,/] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE 765-1802 BUILDING DEPT. [ 1ST ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL INSPECT~~ -FORH NO. ! TOWN OF SOUTUOI,D BUILDING DEPAR3~4ENT TO~/N IIALL SOUTtlOLD, N.Y; ] 1971 ' TEL: 765- 1802 BOARD OF IIEAI,TI1 .. 3 SETS OF PLANS .. SURVEY ........... CUECK ..................... SEPTIC FORH .................. NOTIPYi CALl ................... HAIL TO: .................... APPLICATION FOR BUILDING PERHrI' INSTRUCTIONS a. 'Ihls appl icatioa must b~ completely filled in by typewriter or in ink a~ ~itt~ to ~e ~dldi~ Ins~tor witl' 3 ~ts o~ pla~, acmrate plot pl~ to ~ale. F~ acco~i~ to ~le. b. Plot pl~ ~iq l~ati~ of lot aM o[ h*ildi~s ~ pr~M~s, ~lation~fip to Mjoioing ~i~s or ~lic struts or areas, a~ givit~ a ~tail~ ~ripti~ of la~lt of ~rty ~st ~ dr~ ~ the dia~m ~id~ is ~rt o~ this a~Hcati~. c. ~ ~rk c~r~ by 6~is a~licati~ v~ mt ~ co~ ~fore issue of ~ildi~ Pemit. d. U~ ~al of this ~licati~, tt~ hildi~ lns~ctor will issa~ a ~ildlag ~mit to tim a~lica~. ~h ~mlt ~alI I~ ~pt ~ tim ~i~s ~ail~le for in~ti~ thr~mt the e. ~ ~ildi~ ~mll ~ ~a~i~ or g~ in ~le or in ~rt for ~ ~ ~mt~r ~tll a ~rti[icate of - ~t~,I~'l'[~ 1S I~1~ ~ to-tt~ hsildi~ ~rtnent~foe tl~e iaaa~e of a ~fildi~ Pemit ~r~nt to the ~ildi~ ~ O~i~ of ~ T~ of ~t~ld, ~fffolk ~t~, ~ Yorks ~ other a~llc~le ~, O~i~es or ~Iati~s, for tim ~st~ti~ of l~dldi~s, ~iti~s or alterati~s, or for r~al or ~lition, as Imrein ~ril~. 'llm appli~at a~s to ~ly with all a~li~ble 1~, o~i~ilding ~, I~i~ cede, and ................... (~ilitg ~ess of a~licaut) //ff~ State ~t~tl~r applicant is o~mer, lessee, agent, arddtect, eagineer, general coatrai:tor, electrician, plmber or lmilder. ~ of ~r of p~i~s ............................................. (as ~ tl~ tax roll or latest ~) If a~licant ia a co.ratio, si~ture of ~ly ,aut~riz~ officer, i and title o[ corporate of[icer) earn .., ............ .......... l~pth .............. ct~mtr~:timt violate any ~Ing h~, ordinmme or refinlal:lcm: of JJRIivithml the ......................................................................... ,t~-otn lo I;el:ore riK: thb; ................... ,,n~ ,,~ . . .~. . .q ~ ~ . . .Ze. ,~. .5. .7. . . '~'(8i[~l~;ll'ttre t)fdq~l~,l itmuL)