HomeMy WebLinkAbout23447-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25435
THIS CERTIFIES that the building
ACCESSORY
Dat~: 12/16/97
Location of Property: 890 WILLIS CREEK DR ~ATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 115 Block 17 Lot 17.14
Subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 30, 1996 pursuant to which
Building Permit No. 23447-Z dated MAY 15, 1996
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 ACCESSORY INGROUND SWIMMING POOL FENCED TO CODE AS APPLIED FOR.
The certificate is issued to STEPHEN SPARACINO
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
12473 p6/19/96
N/A
Bu~ld~ Inspectorf
Rev. 1/81
TOWN OF SOUTHOLD
TOWN HALL
$OUTHOLD, N.Y.
N~
BUILDING PERMIT
[THIS PERMIT MUST BE I(EPT ON THE PREMISES UNllL FULL
COMPLETION OF THE WORK AUTHORIZED)
23447 Z Date .......... .,~..~ ./..~..~.. ........................ 1 .~...~.. ....
Permission Is hereby gra~ed to: ,,, ,
........... .~z./.......~.~..~ ............................
............ ,~.~..~.,.~:~.....~.~...../,r.z~.~
to....~~, .~...~. ~.~'~~~)
...... .............
................. :..~...z~.~c¢ ...........................................................................................
at premises located at, ~
................................................................ ~.~.Z~.~ ................................................
¢o~,,~o. ~ ~,,o,.....~ ~,o~, ......... z.z ........ ,o,,o....z..z~...~ ....
pursuant to application dated ............... ~..~ ..... 19,..~..,, and approved bvthe
Building Inspect~,~.~
Rev, 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-i802
'APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 I% 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 cdmpleted site plan requirements.
For existing buildings (prior to April 9, i957) 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
t. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
~ Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00
~ 3, Copy of Certificate of 0ccupancy - ~ .25~
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction .... .~..a..- 01d Or Pre-existing Building .................
~ocation of Property.. Y.?~../~/I/&..E~..' .D~.Zg.~. .... /T&r~.,.'/~k~.. .................
~ouse No. Street HanD_et
Onwer or Owners of Property .........................
County T= ~p No i000, Section .... f~.¥. ..... ~loek ..... 7.7. ....... Lot...XT.~L.~. ..........
Subdivision .... ~.~ .. ~ iled Map ............ Lot ......................
Petit No. ~.~. . ~. 4. Z~ Z. Da~e o~ Fe=it. . ~ :. ~. : ~.4. .Applicant. .¥¢rF~XO. . .
~ealth Dept. Approval...~.. .................... Underwriters Approval., ..~... ,~/'.~/~- ......
/
Planning Board Approval..~.. ...................
Request for: Temporary Certificate ........... Final Certicate....~'/.. .....
..<57x 5 %- nq .....................
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
December 1, 1997
Stephen Sparacino
890 Willis Creek Dr.
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)
XX 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 # 23447-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND [ ] INSULATION
[ ] FRAMING [~'~FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION I ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
[ ] ROUGH PLBG.
[ ~SULATION
[ I/J FINAL
DATE /////~**~/~ ~
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ ] FRAMING
[..~JSULATION
[ ~'] FINAL
[ ] FIREPLACE & CHIMNEY
DATE
TRUSTEES
John M. Bredemeyer, IlL President
Albert J. K_mpski, Jr., Vice President
Henry P. Smith
John B. Tuthill
William G. Albertson
Telephone (51.6) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SUPERVISOR
SCOTT L. HARRIS
Town Hall
53095 Main Road
EO. Box 1179
Southold, New York 11971
October 12, 1993
Young & Young
Planning, Engineering & Land Surveying
400 Ostrander Avenue
Riverhead, NY 11901
RE:
Sparacino Property
SCTM $1000~115-17-17.14
DEC ~1-4738-00847/00001-0
Dear Mr. Wolpert:
The above referenced property was inspected by a representative
of this office. As per survey dated August 2, 1993, this
proposed dwelling is out of the Trustees Jurisdiction.
If you have any further questions, please do not hesitate to
contact this office.
rely, ,~ ·
President, Board of Trustees
JMB: jmd
cc: Stephen Sparacino
Marilyn Peterson, DEC
DEC PERMIT NUMBER
1-4738-00847/00001-0
NEW YORK STATE DEPARTHENT OF ENVIROBHENTAL CONSERVATION
FACZLITY/PROGR~ NUMBER(S)
ITYPE OF PERMIT · New g Renewal
pE vllT
Under the Environmental
Canservation La~
B Modificatiun B Permit to Construct
EFFECTIVE DATE
November 15, 1993
EXPIRATIOR DATE(g)
Novefaber 30, 1996
Permit to Operate
Article 15, Title 5: Protection
of Waters
Article 15, Title 15: Water
Supply
Article 15, Title 15: Water
Transpert
Article 15, Title 15: Long
island Welts
Article 15, Title 27: Wild,
Scenic and Recreational Rivers
6NYCRR 608: Water Quality
Certification
Article 17, Titles 7, 8: SPDES
Article 19: Air Pollution
Control
Article 23, Title 27: Mined Land
Reclamation
Article 24: Freshwater Wetlands
Article 25: Tidal Wetlands
Article 27, Title 7; 6NYCRR 360:
Solid Waste Management
Article 2?, Title 9; 6NYCRR 373:
Hazardous Waste Management
Article ~: Coastal Erosion
#anegement
Article 36: Floodplain
Management
Articles 1, 3, 17, 19, 27, 37;
6NYCRR 380: Radiation Control
Other:
PERMIT ISSUED TO I TELEPHONE NUMSER
Stephen Sparaccino
I
ADDRESS OF PERMiTTEE
P.O. BOX 1300, Rocky Point, NY 11778
CONTACT PERSON FOR PERMITTED ~ORK TELEPHONE NUMBER
Thomas Wolpert, young & Young 400 Ostrander Ave., Riverheod~ NY 11901
NAME AND ADDRESS OF PROJECT/FACILITY
Sparaccino Property - Willis Creek Drive
LOCATION OF PROJECT/FACILITY
Mattituck
SuffolkCOUNTY ISoutholdTOWN IWATERCOURSE NYTM COORDINATES
DES IP IC CF 'TIVITY /
Construct a single family dwelling, swimming pool, deck, driveway, sanitary systan and/~approxinmtely 1400 cubic yards of
clean fill. All work shall be in accordance with the attached NYSDEC approvod plan.
By acceptance of this permit, the permlttee agrees that the permit is contingent upon strict compliance with the
ECL, all applicable regulations, the General Conditions specified (see page 2) and any Special Conditions included as part of
this permit.
REGIONAL PERMIT ADMINISTRATOR: ADDRESS
Robert A. Greene
Bldg. 40, SUNY, Room 219, Stony Brook, NY 11790-2356
AUTHORIZED SI GNATURE //~ * -~' ~.~-~_~.E~~/~/~' ~- ' -- IDATE
/.~'~/~ //'~;~f,~i November 15. 1993
I Page I of 5
BLDG. DEPT.
TOWN OF SOUTHOLD
Inspect ior~s
1, The permitted site or facility, including relevant records, is subject to in-
inspection at reasonable hours and intervals by an authorized representative of
the Depari~runt of Envirom~ntal Conservation (the Departrrent) to determine
whether the permittee is ccrrplying with this permit and the ECL. Such represen-
tat ive may order the work suspended pursuant to ECL 71-0301 and S~PA 401 (3). A
copy, of this permit, including all referenced maps, draNings and special
conditions, r~ust be available for inspection by the Deperl,'ent at all times at
the project site. Failure to produce a copy of the permit upon request by a
Deparb~ent representative is a violation of this permit.
Permit Changes and Flenemels
2. The Deparafunt reserves the right to m~dify, suspend or revoke this permit when:
a) the scope of the permitted activity is exceeded or a violation of any
condition of the permit or provisions of the ECL and pertinent regula-
tions is found;
b) the permit was obtained by misrepresentation or fai lure to disclose
relevant facts;
c) nevvmaterial information is discovered; or
d) enviroH~ntal conditions, relevant technology, or applicable lev or
regulation have material ly changed since the permit was issued.
The permittee trust submit a separate written application to the Department for
renewal, rrodification or transfer of this permit. Such applicationrrust include
any fo.~6, fees or supplemental infom'ation the Department requires. Any
renege I, nod i ficat ion or transfer granted by the Depar'cnent must be in wr i t ing.
The permitteerrust submit a renewal application at least:
a) 180 days before expiration of permits for State Pollutant Discharge
Elimination Systmn (SF[~ES), Hazardous W~ste Management Facilities
(PI/~I=), major Air Pollution Control (AFC) and Solid W~ste Management
Facilities (E~F); and
b) 30 days before expiration of all other permit types.
Other
6.
Unless expressly provided for by the Depart~'ent, issuance of this permit does
not rrodify supersede or rescind _a, ny order or determination previously issued byI
the Deparb~'ent or any of the ter,'~ conditions or requireYents contained in such
order or d. etermination. I
Lega CblJgations of Permittee I
The permittee has accepted expressly, by the execution of the application, the
full legal responsibility for all damages, direct or indirect, of whatever
nature and by whu¥~ver suffered, arising out of the project described in this
permit and has agreed to indur~'~ify and save harmless the State fro'n suits,
actions, da~'ages and Costs of every n~u and description resulting frcm this
project.
4
This permit does not convey to the permittee any right to trespass upon the
lands or interfere with the riparian rights of others in order to perform the
permitted work nor does it authorize the irrpai~3~nt of any rights, title, or
interest in real or personal property held or vested in a person not a party to
the permit.
The permittee is responsible for obtaining any other permits, approvals,
easu~'ents and .~t,?a~y be requi red for this project.
,Itl 3 0 1996 2
lands,
ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24,
25, 34 and 6 NYCRR Part 608 ( )
other enwronmentaJly deletenous materials assooated with the
project
1 ~ Any material dredged m the prosecuuon ot the work hereto perm*tted
shah be removed evenly, w~thout leawng large refuse pdes, ridges across
the bed of a waterway or floodplain or deep holes that may have a
tendency to cause damage to nawgable channels or to the banks of
a waterway
14 There shall be no unreasonable interference w~th nawgation by the work
her~,m authorized
15 If upon the expiration or revocation of th~s permit, the prolect hereby
authorized has not been completed, the apphcant shall, w~thout expense
to the State, and to such extent and m such t~me and manner as the
Department of Enw¢onmental Conservation may require, remove all ar
any portton of the uncompleted structure or fd[ and restore the site
to its former cond,t~on NoclmmshaH be madeagamst the State of
New York on account of any such removal or alteration
16 If granted under 6 NYCRR Part 608, the NYS Department of Environ-
mental Conservation hereby certifies that the subject pro]ect wdl not
contravene effluent hm~tahons or other limitations or standards under
Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977
(PL 95-217) prowded that all of the conditions hsted hereto are met
17 Ali acuwUes authorized by th~s permit must be in strict conformance
w~th the approved plans submitted by the apphcant or his agent as part
of the permit applicahon
Such approved plans were prepared by
~:~: SPMCIAL C~%~ITION #1 o.
SPECIAl. CONDITIONS
A permanent 25' no disturbance buffer area must be
established immediately landward of the tidal wetland
boundary, and a revised plan must be submitted to the
Department within 30 days of commencement, indicating this
buffer area.
Ail necessary precautions shall be taken to prevent
contamination of the tidal wetlands and/or waters of
York by silt, sediment, fuels, solvent, lubricants,
coatings, concrete leachate and any other pollutant
associated with project work.
Any debris or excess material from construction of this
project shall be completely removed from the adjacent
(upland) and removed to an approved upland area for
disposal. No debris is permitted in tidal wetlands.
The storage of construction equipment and materials shall be
confined to within the project work site and/or upland areas
greater than 50 linear feet distant from the tidal wetland
boundary.
5. A row of staked hay bales or approvable erosion control
devices shall be placed as per approved plan at commencement
of regulated activities and remain in place until project is
completed and all disturbed areas stabilized with
Page
95-20-5[ (7187)--25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
SPECIAL CONDITIONS
25 Tidal Wetlands
For Article_ (. )
e
e
Se
9.
10.
11.
If seeding or soil stabilization is impracticable due to the
time of year, a temporary mulch shall be applied and final
seeding shall be performed at the earliest opportunity when
weather conditions favor germination and growth, but not
more than six months after project completion.
Roof runoff shall be directed to drywells a minimum of 100'
landward of the tidal wetland boundary for immediate on-site
recharge.
Dry wells for pool filter backwash shall be located a
minimum of 100' landward o the tidal wetland boundary.
There will be no draining of swimming pool water directly or
indirectly into tidal wetlands.
Project must comply with all local and federal floodplain
regulations.
Ail fill shall consist of "clean" gravel and soil (not
asphalt, slag, flyash, broken concrete or demolition
debris).
Supplementary Special Conditions (A) thru (F) attached..
SUPPLEMENTARy SPECIAL CONDITIONS
The following conditions apply to all permits:
A copy of this permit, including all conditions and approved
plans, shall be available at the project site whenever authorized
work is in progress. The permit sign enclosed with the permit
shall be protected from the weather and posted in a conspicuous
location at the work site until all authorized work has been
completed.
The permittee shall require that any contractor, project engineer,
or other person responsible for the overall supervision of this
project reads, understands, and complies with this permit and all
its general, special, and supplementary special conditions. Any
failure to comply precisely with all of the terms and conditions
of this permit, unless authorized in writing, shall be treated as
a violation of the Environmental Conservation Law. If any of the
permit conditions are unclear, the permittee must contact the
Division of Regulatory Affairs at the address on page one or
telephone (516) 444-0365.
If project design m6difications become necessary after permit
issuance, the permittee shall submit the appropriate plan changes
for approval by the Regional Permit Administrator prior to
undertaking any such modifications. The permittee is advised that
substantial modification may require submission of a new
application for permit.
Do
At least two days prior to commencement of the project, the
permittee and contractor shall sign and return the top portion of
the enclosed notification form certifying that they are fully
aware of and understand all terms and conditions of this permit.
Within 30 days of completion of the authorized work, the bottom
portion of that form shall also be signed and returned, along with
photographs of the completed work and, if required, a survey.
For projects involving activities to be undertaken in phases over
a period of more than one year, the permittee shall notify the
Regional Permit Administrator in writing at least 48 hours prior
to recommencing work in subsequent years.
The granting of this permit does not relieve the permittee of the
r~sponsibility of obtaining a grant, easement, or other necessary
approval from the Division of Land Utilization, Office of General
Services, Tower Building, Empire State Plaza, Albany, NY 12242
(515) 474-2195, which may be required for any encroachment upon
State-owned lands underwater.
DEC Permit
APR ~9 '96 09:41 TOWN OF SOUTHOLD
Albert $. grupski, l~esident
John Holzapfel, Vice President
Jim King
Martin H. Garrell
Peter Wenczel
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
P.l?l
Town Hall
53095 Main Road
P.O. Box 1179
SouthOld, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
~PRIL 29, 1996
Eve Miller
Swim King Pools
471 Route 25A
Rocky Point, NY 11778
RE: Stephen Sparacino
SCTM #1000-115-17-1%~4
Dear Ms. Miller:
The above referenced property was inspected with regard to the
proposed swimming pool.
As long as all activity stays lalldward o~ the ~ence and a row o£
staked haybale$ is placed at the bottom of slope, the pool is
out of the Trustees jurisdiction.
This is not an approval from any other agency.
If you have any further questions, please do not hesitate to
contact this offioe.
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:jmd
cc: Bldg. Dept.
, ~QWN OF $OUTHOLD
t)
" Il! !
A
A
BLDG. DEFT.
'"~JM OF SOUTHOLO
*FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Exa,nined
Disapproved a/c .............. i .......................
APPL~ATION FOR BUILDING PERMIT
BOARD OF HEALTH ......
3 SETS OF PLANS .......
SURVEY ......... ,
CHECK ..........
SEPTIC FORM ·
NOTIFY
CALL ................
MAIL TO:
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 ~cale. 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 desc'ription of layout of property must be drawn 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, p~emises available for inspection throughout the work.
e. No building Shall be occupted or used in whole or in part for any purpose whatever until 0 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 w th all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on pre: aides and in building for necessary inspections.
,
(~S~gnature of applicant, or name, u a co p t'
' ,, (Mailing address of applicant)
' e chltc (nl te~er! ~.~e~e~a co~t~rra!torO~, electrlclan "lumber or builder
State whether applicant is_own r lessee, agent, ar ' e t, e g'n , g , ' ' , v ·
Name odwner of premises%L~f'{~ ~...~..~.~~ ........ ' ...............................
(as on the tax roll or latest deed)
If app:~p~t~rized, officer.
'Al~Bui~dOerN,~ceCnTs~q~.S~.~S~./.B,=~ ~77.~K...Cy.U.N.T¥ LICE,BE1D
Plumber's ~icense No .... ~.~/,~. .... ~.~ ........
Electrician sLicense No. /..~]..~. ?...~..~. ........
Other Trade's License No..~.../~. ...........
1. Location of land on which pro: ~osed work will be done. .................................................
House Number Street . Hamlet
County Tax Map No. 1000 Section'. ~.l~. ............ -. Block..]..~.. ' Lot.../.?.d.~....: · · · .
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupan :y of premises and intended use and occppancy of proposed construction: '
a. Existing t/se and °ccupancyi'¥~' '~"J'~' '~' · ' P'~'~' · ~' · '~' '5'(-~f' '~' '"' ' -- -- t--,~:'"- .... " .....
b. Intended use and occupanc~ . / ~...)(, ~.c::~,.[k'O~ffLD~(~. ~4~..~./~.i .~/
3. Nature of work (check which applicable): New Building ..... ' ..... Addition ....... .~.'~%~3T~i~BI~P'-~'~~ :. - -e -
Repair .......... Removal .............. Demolition .............. Other .W, or.k l ~~.~
4. Estimated Cost ........ ~.~.1 ~ jJ2D "Fee .................
· (to be paid on fihng thru application)
5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor ................
If garage, number of cars ........................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions'of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
-- 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Size of lot: Front ...................... Rear ...................... Depth ......................
10. Date of Purchase ............................. Name of Former Owner .............................
11. Zone or use district in which premises are situated ...................... [.1 .............................
12. Does proposed construction violate any zoning law, ordinance or regulation: . [.¥.0 ...........................
13. Will lot be regraded '~ ......................... ..,. Will excess_fill he removed fro~ premises:~ Yes No
14. Name of Owner of premis~]~.'~tq .~ ~If.'.~/~ddress .~ .~J[~ ~'.~(l~one N~7 .~. ~.~7~..'7-/
Name of Architect ..................... Address ........... - .~..V..~Phone No ............. .'..
Name of Contractor~.~.. :~ ....... AddreSS..~:?x.~..~.::: Phone
15. Is this property located within 300 feet of a tfffalYw~'q~land? *Yesx.
*If yes, Southold Town Trustees Permit maybe required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail 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 corner lot.
UND£RV,IRIIERS CER'fIFICAIE
REQUIRED
"IMMEDIATEly,,
ENCLOSE POOL TO CODE
UPON COmPLETIoN
BEFORE 'WATER"
~,~OT,FV ~U~U~"~ y':~' FOR
FOLLOWING iNSPEcTIONS:
1. FouNDATION ' TWO REQUIRED
FOR POURED CONC~TE
~. RouGH ' FRAMING A PLUMBIHG
3. INSU~TION
4. FINAL - CONSTRUCTION MUST
BE coMpLETE FOR C.O.
ALL coNSTRUCTION 8HALL ~EET
THE REQUIREMENTS OF THE N.Y,
STATE cONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRU~ON ERRORS
STATE OF NEW YORK, S.S
COUNTY OF ..... ~ ....... A ~ .
.... /,~.~(~.~.../.'... ~[.~)d~. K..~. · · ....... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ..............................
of said owner or owners, ~d is duly authorized to perfo~ or have performed the said work and to m~e and file this
application; that ail statements contained ~ this application am true to the best of his knowledge and belief; and that the
work will be perfo~ed in the m~ner set forth ~ the application filed therewith.
Sworn to before me this
............ ....... .... '
Notaw Public, . ........... ~ ...... . County. ~
. No 52~2643~.