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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~.