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HomeMy WebLinkAbout22340-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23697 Date JUNE 12, 1995 THIS CERTIFIES that the building ADDITION Location of Property 1695 CHABLIS PATH SOUTHOLD NY House No. Street Hamlet County Tax Map No. 1000 Section 51 Block 3 Lot 3.7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 21, 1994 pursuant to which Building Permit No. 22340-Z dated SEPTEMBER 19, 1994 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 A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR AND TO THE CONDITIONS OF THE ZBA APPEAL #4265 DATED SEPTEMBER 7, 1994. The certificate is issued to PETER DE NICOLA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ild ng Inspector Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date 9..................... 19Y.) N°_ 22340 Z Permission Is hereby grante o: / J Q kAz- !J e Ali 6O (#4 t°.Q..!...Gc ........1 .....~.u-`~...C.C...1.1~C `f (.r, g.V ..N... s.. Gi.... .p 5'~...../- ~j,.........ar) Pr.. ..l ..1.e ..1'L.......tN.d....~.....Vi. A.. ...t .d.i..7.fL0.'.N.,9.... 57 7 , ..2 .~.N1..!.. ........9.~~~19 T' at premises located at............ I.....t...7...`...... County Tax Map No. 1000 Section Block Lot No. . pursuant to application dated I 19........T and approved by the Building Inspector. Fee S.... Building Inspector Rev. 6/30/80 Form No. 6 2) ja- • TOWN OF SOUTHOLD fir` I BUILDING nEP;RTNGNT JUN - 9 X995 ,.'n TOWN HALL 765-1802 P? Q_ „JI APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2• Final Approval from health Dept. of water supply and sewerage-disposal(S-9 form. 3• Approval of electriceul installation from Board of Fire Underwriters. ) 4: Sworn statement from1plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial buildin , industrial building, multiple residences and similar buildings and installations,~a certificate of Code Compliance from architect or engineer responsible for the building, 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00" , Commeercial $15.00 Date . New Construction......... Old Or Pre-exist' g Buildinng.. / . 1 f Location of Property..... 4.6.q~...... ...ski ...~~'.Q G.~......... so®,LZ. P.~_. House No. ~Streef Hamlet Onwer or owners ~:f Property...... ~~r / 1~(0 C) ll County Tax Map No 1000, Section ...ONA N'AP ..Block. . .Lot.. .©p.7a.:4~~.7 Subdivision.n l,~~0e1?n C190o~~ py SOct eLDFiled Mnp..IDIDpp ~Z 7 ?ermit No.. .IgD2••,pate Of Permit.0010 ~tg2 Kalth Dept. Approval ..........................Underwriters Approval Tanning Board Approval tequest for: Temporary Certificate........... Final Certicate..... ~ 'eel SSubbm'iltte~d~: $..f T•.00... . a~~,LA =~O~OSUFFO(KcpGy~ Town Hall, 53095 Main Road W Fax (516) 765.1823 P. O. Box 1179 Telephone (516) 765-1802 Southold, New York 11971 1j X01 ,~a OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD June 2, 1995 Mr. Peter De Nicola P.O. Box 841 Southold, NY 11971 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) 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 # 22340-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. MINTZ Y \ a , II m (v a NDATIOV INDATI0;1 (2nd) tGH FRAME ••c:,•-PLU1.IBING• I y.::. t H w\ rn m v1• ;ULATION PER N. Y. II m • H STATE ENERGY II CODE - I j FI;IAL I - ADDITIONAL COMMENTS: ~ • x Q .a • H ~l \ O 7 ' r t7. m 4A%'.r'-'-~•' ::x.29aeti....r-.:ti• c•.... r~5:ti-•~.;..i.:..•a. . , t .-3 ..~?r.;ln; 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: C- DATE //INSPECTOR 6 ~ APPEALS BOARD MEMBERS Southold Town Hall Gerard P. Goehringer, Chairman r°n T 53095 Main Road Serge Doyen, Jr. ~+p P.O. Box 1179 71 James A. Villa - y'h01 ~a0~ Southold, (516) 765-1823 Robert Richard C. Wilton Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD September 15, 1994 M P X5 I SAP 1994 Mr. Peter DeNicola ~ P.O. Box 841 Southold, NY 11971 TOWN BLDG. Re: Appl. No. 4265 - Deck Addition (Rear Yard Setback) Dear Mr. DeNicola: Please find enclosed a copy of the findings and determination rendered by the Board of Appeals concerning your variance application filed by you. A copy of this determination has also been forwarded to the Building Department for their update on the pending building permit application. Due to the proximity of this project within 500 feet of a waterway or a County Road, we have transmitted copies of this file to the Suffolk County Department of Planning as required under the County's Administrative Code. Once they have finalized their review and forwarded their comments to our office, we will transmit a copy of the same to you for your update. Very truly yours, Linda Kowalski, Clerk Board of Appeals Enclosure Copies of Decision to: Building Department Suffolk County Planning Commission ~~S~FFOLK~~ APPEALS BOARD MEMBERS ~O G,f Southold Town Hall Gerard P. Goehringer, Chairman COD m 53095 Main Road Serge Doyen, Jr. P.O. Box 1179 James Roberti A. Villa r. Southold, 765- 71 1823 Richard C. Wilton Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD ACTION OF THE BOARD OF APPEALS Appeal No. 4265: Application for PETER DeNICOLA. Variance ~ to the Zoning Ordinance, Article IIIA, Section 100-30A.3 for permission to construct deck addition to existing dwelling with a setback at less than the requirement (50 feet). Location of Property: 1694 Chablis Path, Southold, NY; Lot No. 7 on the Map of Chardonnay Woods; County Tax Map Parcel No. 1000-51-3-3.7. The subject premises contains a total lot area of 40,000 square feet. WHEREAS, a public hearing was held on September 7, 1994, at which time those who desired to be heard were heard and their testimony recorded (no opposition was received); and WHEREAS, the Board has carefully considered all testimony and documentation submitted concerning this application; and WHEREAS, the Board Members have personally viewed and are familiar with the premises in question, the present use and zone district, and the surrounding areas; and WHEREAS, the Board made the following findings of fact: 1. This is an application for a variance to construct an open (unenclosed) deck addition with a setback of 30 feet from the rear property line, at its closest point. 2. The premises in question is known as Lot No. 7 on the Cluster Development Map of Chardonnay Woods at Southold, filed as Map No. 8822 on September 28, 1989 in the Office of the Clerk of Suffolk County. This parcel consists of a total lot area of .918 acre, or 40,000 sq. ft., is presently located in the A-C Zone District, and is identified on the Suffolk County Tax Maps as District 1000, Section 51, Block 3, Lot 3.7. 3. The amount of relief requested is 20 feet, for a reduction from 50 feet to 30 feet due to the shape of the lot and the radius of the setback lines along an are from Chablis Path. 4. In considering this application, the Board also finds: Page 2 - Appeal No. 1265 Application of PETER! DeNICOLA Decision Rendered September 7, 1994 i (a) that the new deck addition, as proposed, will not be an adverse impact to Ithe essential character of the neighborhood, although the relief requested in this application is substantial in relation to the 50-ft. "setback requirement; (b) that the variance will not in turn be adverse to the safety, health, welfare, comfort, convenience or order of the town, or be adverse to neighboring properties; (c) that the addition is not an activity which would cause an increase in dwelling unit density or cause a substantial effect on available governmental facilities; (d) that the addition is not major construction, being an open, unenclosed deck and the applicant has agreed to a restriction in this respect; (e) in considering all of the above factors, the interests of justice will be served by granting the reduction as requested and further noted below.) Accordingly, onilmotion by Chairman Goehringer, seconded by Members Doyen and Dinizio, it was RESOLVED, to I GRANT the requested reduction for a 30-ft setback from the rear property line, at its closest point, and as shown on the diagra submitted under this application, SUBJECT TO THE FOLLOWING CONDITIONS: 1. That the ideck addition remain open and unenclosed, as agreed; 2. That the rear yard setback not be further reduced, and no other construction extended, unless compliance for the new construction (outside' of the subject deck) is met with the rear yard requirements of the zoning code (presently required at 50 feet). Vote of the Board: Ayes: Messrs. Goehringer, Doyen, Dinizio, and Villa. (Member Wilton was absent.) This resolution was duly adopted. ' s / GERARD P. GO RING , CHAIRMAN II 6/ ~OSpPFOCKCOG APPEALS BOARD MEMBERS Southold Town Hall Gerard P. Goehringer, Chairman co 53095 Main Road Serge Doyen, Jr. vp • P.O. Box 1179 James Dinizio, Jr. Southold, New York 11971 Robert A. Villa Fax (516) 765-1823 Richard C. Wilton Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD ACTION OF THE BOARD OF APPEALS Appeal No. 4265: Application for PETER DeNICOLA. Variance 'to the Zoning Ordinance, Article IIIA, Section 100-30A.3 for permission to construct deck addition to existing dwelling with a setback at less than the requirement (50 feet). Location of Property: 1694 Chablis Path, Southold, NY; Lot No. 7 on the Map of Chardonnay Woods; County Tax Map Parcel No. 1000-51-3-3.7. The subject premises contains a total lot area of 40,000 square feet. WHEREAS, a public hearing was held on September 7, 1994, at which time those who desired to be heard were heard and their testimony recorded (no opposition was received); and WHEREAS, the Board has carefully considered all testimony and documentation submitted concerning this application; and WHEREAS, the Board Members have personally viewed and are familiar with the premises in question, the present use and zone district, and the surrounding areas; and WHEREAS, the Board made the following findings of fact: 1. This is an application for a variance to construct an open (unenclosed) deck addition with a setback of 30 feet from the rear property line, at its closest point. 2. The premises in question is known as Lot No. 7 on the Cluster Development Map of Chardonnay Woods at Southold, filed as Map No. 8822 on September 28, 1989 in the Office of the Clerk of Suffolk County. This parcel consists of a total lot area of .918 acre, or 40,000 sq. ft., is presently located in the A-C Zone District, and is identified on the Suffolk County Tax Maps as District 1000, Section 51, Block 3, Lot 3.7. 3. The amount of relief requested is 20 feet, for a reduction from 50 feet to 30 feet due to the shape of the lot and the radius of the setback lines along an are from Chablis Path. 4. In considering this application, the Board also finds: Page 2 - Appeal No. 4265 Application of PETER DeNICOLA Decision Rendered September 7, 1994 (a) that the new deck addition, as proposed, will not be an adverse impact to the essential character of the neighborhood, although the relief requested in this application is substantial in relation to the 50-ft. setback requirement; (b) that the variance will not in turn be adverse to the safety, health, welfare, comfort, convenience or order of the town, or be adverse to neighboring properties; (c) that the addition is not an activity which would cause an increase in dwelling unit density or cause a substantial effect on available governmental facilities; (d) that the addition is not major construction, being an open, unenclosed deck and the applicant has agreed to a restriction in this respect; (e) in considering all of the above factors, the interests of justice will be served by granting the reduction as requested and further noted below. Accordingly, on motion by Chairman Goehringer, seconded by Members Doyen and Dinizio, it was RESOLVED, to GRANT the requested reduction for a 30-ft setback from the rear property line, at its closest point, and as shown on the diagram submitted under this application, SUBJECT TO THE FOLLOWING CONDITIONS: 1. That the deck addition remain open and unenclosed, as agreed; 2. That the rear yard setback not be further reduced, and no other construction extended, unless compliance for the new construction (outside of the subject deck) is met with the rear yard requirements of the zoning code (presently required at 50 feet). Vote of the Board: Ayes: Messrs. Goehringer, Doyen, Dinizio, and Villa. (Member Wilton was absent.) This resolution was duly adopted. lk ZGERARD P. GO RINGS , CHAIRMAN FORM NO. 3 TOWN OF SO U-17110 LD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date .....August 12 :............19 94 To .......•Peter•DeNicola P.O. Box 841 Southold, N.Y. 11971 PLEASE TAKE NOTICE that your application dated • •July.21, t 19.94• for permit to Construct a deck addition to an existing one family dwellingat Location of Property 1694 Chablis Pa.th....... Southold ' House No. Street " " " ' • • • • • • • County Tax Map No. 1000 Section ...11 • • • Harrier Block ......:3...... Lot 3.7 Subdivision Filed Map No. Lot No. is returned herewith and disapproved on the followin° grounds ..Under Article III A Section 100,30 A.3 of the Town of Southold Zoning Code proposed construction will have insufficient rear yard set back. Action required by the Zoning Board of Appeals. i • Tnspc or Buiding RV 1/80 BOARD OF APPEALS. TOWN OF SOUTHOLD In the Matter of the Petition of NOTICE TO to the Board of Appeals of the Town of Southold ADJACENT. TO: PROPERTY OWNER YOU ARE HEREBY GIVEN NOTICE: 1. Th intention of the undersigned to petition the Board of Appeals of the Town of Southold to request (Variance) pecial Exception) (Special Permit) . (Other) (circle choicel 1. 2. That the property which is the subject oft eetition is~o cl adjar~en tq your property and is des- cribed as follows: tt h. >_2 Sso 64l C{v 9 ? MW 3. That the property which is the subject of such Petition is located in the following zoning district: 4 That by such Petition, the undersigned will request the following relief: ILIA CtJ,L1~ F-./. ®c~ } ~0~ ~pat< C~dR6 ~~9A>Kenyn~ 5. That the provisions of the Southold Town Zoning Code applicable to the relief sought by the under- signed are Article Section [ ] Section 280-A, New York Town Law for approval of access over right(s)-of-way. 6. That within five days from the date hereof, a written Petition requesting the relief specified above will be filed in the Southold Town Clerk's Office at Main Road Southold, New York and you may then and there examine the same during regular office hours. (516) 7~5-1809. 7. That before the relief sought may be granted, a public hearing must be held on the matter by the Board of Appeals; that a notice of such hearing must be published at least five days prior to the date of such hearing in the Suffolk Times and in the Long Island Traveler-Mattituck Watchman, newspapers published in the Town of Southold and designated for the publication of such notices; that you or your representative have the right to appear and be heard at such hearing. Dated: T~~9 Pe4ee- '(~e~~ cotes 'Petitioner P-r Owners'Names: eve Post Office Address 1~ C9.130fC ~f' ~ / Cnct~Ft`dCl~~!`f•~'i, 119'/ Tel. No. (~>lo) 7(oS ~'316 -9 [Copy of sketch or plan showing proposal to be attached for convenience purposes.] ! PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS NAM ADDRESS D1 c~~- s3n9r makes ~tlG~ ~To I I!I III I I I I STATE OF NEW YORK) ss.: COUNTY OF SUFFOLK) residing at C~ a f3LiS r L6 being duly sworn', deposes and says that on the _ (_Z_ day , 19 deponent mailed a true copy of the Notice set forth on the re- Of verse side h reof, directed to each of the above-named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the addresses of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Of- fice at Sco wa- Q.1111 ; that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to ore me thi y of ef lC 9 Notary Public CLAIRE L. GLEW ! Notary Public, State of Now York No.48795Q5 Qualified In Suffolk Cou W Commission Expires Decembet 8,19 ! (This side does not have to be completed on form transmitted to adjoining property owners.) V N00°50'30''4l N54,81 9 ~T V , N ~ W 0 cx) o N UI r 4' o 1 3, l4t v I a u 39 y, v 4 f d, ~4k s v? V lJ ~ "'mop m Nn _ ~C N_ ~pk a N Ci N J~ A^~ l o w ~ ~ 3 T'3 ~NJ~6 ° i fm 'O .'E bn mz 3 o 0 b, cn a>bCO v 0 22 w a Wo - ~oA - O lp u ~ e ~ g h p o n~ ~ V C ry O ~ N n V W r E v k! EON ` ^ n n 03 06 O F o G~ , f m l Q c" E my~N^b o w~l - a bm S ~ a 11 L - _ VTV ~r°d'y~zf V L y ~O V 4 a if L ui o v y I' _W o o ° E D. II VA t-00%% t N X o° N K 04, 30 Q \R: 1 \ n v os 0-0 Ol M :*E N ~J ED o N \ I8'~S /41,0£',OSo00N R R BOARD OF HEALTH • . • • • . p uu FORM NO.1 3 SETS OF PLANS TOWN OFSOUTHOLD SURVEY 2 11994 BUILDING DEPARTMENT CHECK _ , TOWN HALL SEPTIC FOR:1 SOUTHOLD, N.Y. 11971 BLDG DEPT. §OU HOLD TEL.: 765-1802 NOT1FY; -7/_s 53Ce~ TOWN 0 OF SOU t lU O p CALL Examined ..P./.. 191, K n~ C, MAIL. TO: APProved 1911Pe No.v°~ O Disapproved a/c c... ,-gl,/?/ 6' '1 (Building Inspector PLICATION FOR BUILDING PERMIT Date q..l....... 19c~ 7Y INSTRUCTIONS a. This application must be, completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this 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 inspectio r~ 14 (Signature of applicant, or name, if a corporation) ~QQQSC g~I I :..~da~?.e1~:~,..11`3.`?l. . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..........na~~?~ Name of owner of premises , a,+2, blp.wl e~ (as on the tax roll or latest deed) If applicant is a corporation, signature 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. G(cQ!5 A_4s..... .a..L ~~.nLD........... House Number Street • • Hamlet County Tax Map No. 1000 Section , , , , , , Block : ©Jfp,.~....:... Lot.. ®-:).c©®.7 , , . Subdivision 64- iled Map No. . O.o),7, Lot ...7......... . Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy `.Vr_Rl7r> A t~ , , , , . b. Intended use and occupancy ~~,G®, R aturee air o • w. , or . (check which , ~ applicable): New Building h ' Addition F'....,.~• Removal , , , , , , , , , , , , , , Demolition Other Work . 4. Estimated Cost . r ((DDe~sc~ription) 4• Fee........ w.~ . ..,..~,,jAjs,application garage, number of dwelling units . . . . If dwelling, Number of dwelling ~ . to units on each lfloor number of cars . . 6. If business commercial or mixed2' , 7. Dimensions of existing structu occupancy, Specify, nature and extent of.each type of use P i-es, if any: Front . ''j. Rear ! Depth ...Yf)f, Height " 3 , , , , , Number of Stories . , Dimensions of same structure with alterations or additions: Front •j..l ,Rear , r , Depth &Q Height ~2 r..,:. . . . .•Num6er of Stories ear . $ Hei-ht of entire new construction: Front ....O ' ' Rear'... JS~. Depth ...f~......... Number of Stories . Reai . . 9. Size of lot: Front 77). t ~ • 10. Date of Purchase . 3Depth .q.........'..... • . n~ 11. Zone or use district in which p remises are situated . Na me of Pormei Owner c , • me of , . 13. Will lot be regraded , Ass.hv y!?, , ~ g}ee~S..... . . 12. Does proposed construction V' "I to any zoning law, ordinance or regulation: .....1` 0.* Name of Owner of premises Will excess fill be removed from premises: Yes 14. ..',~2.?L-~~~.~,1 CuLln ,Address . Name of Architect Phone No......... . Name of Contractor . 4. f " " Address Phone No......... . . 15.' Is this property within 300 feet of a tidaldwetland?' •Phon No *If yes, Southold frown Trustees Permit may be required. No.•`• " PLOT DIAGRAM Locate clearly and distinctly all, buildings, whether existing or proposed, and. indicate all 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. 1 . I STATE OF NEW YORK, _'OUNTY O (Name ofyin~dividual si mn~S • • • , , being duly sworn, deposes and says that he is the applicant contract) bove named. i le is the . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this )plication; that all statements contain} d in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner sot forth in the application filed therewith. vorn to before me this ..:.......daY of I . 19 Z `f" )tary Public, j4-1/.~ County . UNDAA COORM (Signature of applicant) Notary PubRa Stato No. 4822668 SuHdk Count~v Term E olres Decern6er a, I o be lAi cote, Si ~e~ Ce zxy (-~a. o Qa 1 30 3 ) ~ \X1 L1 csk YeLS 1o"/ QC' 4~~i ~1oS'f ~\(y ~+o'41'n w. I~~.i L ` f.eDO A Q?C IG1 N S - axe .b ore-- r W1 y~' c~l~C1a %3a tS \ \ '1* \ vast- I UNDERWRITERS CERTIFICATE REQUIRED i i e I/ I y r n s, i ~1) _JAI - - ~ - - AQPRO ED AS NOTED 2' 31 DATE. ~ ~~L~cle. wG~iC. 7, Y. FEE: •J--- BD E NOTIFY BU9LDING B.e a a 3 ~ PA AT 765-1302 9 AM TO 4 P FOR THE r FOLLOWING INSPECTIONS: O _ _ FOUNDATION - TWO REQUIRED FOR POURED CONCRETE I J 172)UGl-I - FRAMING i5 PLUNdPiING ^.gRTION - "^ISTRUCTION MUST 4-Z 'FT 1 I hU iIUN Ml:ur.. 6 dp°~~,''" F2CMCh~~ ~ J'~ 'I' 11)4 5yw d' [ GPI'- 4 0 4 dr i I L„