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Home My WebLink About20285-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20417 Date DECEMBER 18~ 1991 THIS CERTIFIES that the buildin~ Location of Property 13500 MAIN RODD House No. County T~x Map No. 1000 Section 114 Subdivision ALTERATION MATTITUCK~ N.Y. Street Hamlet Block 1i Lot 5 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 15, 1991 pursuant to which Building Permit No. 20285-Z dated NOVEMBER 20, 1991 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 ALTERATIONS FOR RETAIL STORE (BOUTIQUE) IN EXISTING BUILDING AS APPLIED FOR. The certificate is issued to of the aforesaid building. JOSEPH & BETTY HARDY (owners) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-216655 - DECEMBER 12~ 1991 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ~vOuM NO, It TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREN~ISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 20285 Z Date ../.~ ..~ ............................. Permission is hereby granted to: _ / / ............................... a rem,ses located ~tt ..../.~..~..~...~.....~.... ~....~.. ..................... tp ..... ~,~~ ................................................................. County Tax Map No. 1000 Section .../.../...~... ........... Block ...../..,~. ............. Lot No ...... ~.~ ....... pursuant to application doted ././..~.../..~....'~... 19..~../..., and approved by the Building Inspector. Fae $.../..~..~ Rev. 6/30/80 ......................... ~:..~?~?.~,-~ Form No. 6 ~' ~ ........... :~' ................. " ~ TOWN OF SOUTIIOLD ~ , , OEO i 01991 /1 ~O~P~N~ DEPARTMENT : ",~} ',' ,.~ , j.:/) ~',~ 765-i802 ~PLICATZON FOR CERTIFICATE OF OCCUPANCY ,, o, sotmmm 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 1% 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. Submit Planning Board Approval of completed site plan requirements. 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $I0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Conmercial $15.00 Date ...... ................... ... . .. ~;ew Construction ........... Old Or Pre-existing Building...~.. ........... Location of Property../.~.~. ~.~... l~J~ .~Tp.~) ..... ~.~.~T~.~ ...... House No. Street Hamlet Onwer or Owners of Property...~.~.~-.~J~..f..~.~/~...~..~7~.~ .......................... .. . . County Tax Map No 1000, Section .... 4(~ ....... Block...JJ ........... Lot..~ ................ '~ubdivision Filed Map Lot Permit No..~.~.~ .~.. .... Date Of Permit ................ Applicant..~.~..d~..~ .......... !lealth Dept. Approval ........................ -- Underwriters Approval ......................... Planning Board Approval Request 'for: Fee Submitted: Temporhry Certificate ........... Final Certicate ........... THE NEW YORK BOARD OF FIRE UNDERWRITERS ]"[9~C17'~ BUREAU OF ELECTRICITY [~ 85 JOHN STREET, NEIA( YORK, NEW YORK 10038 ~ "~;,,~' ~B' ,R I ~, ~ <~9~{ 0~ ~?~/91 ~ :~1 g~J~5 Date Application No. on file TH[~ G[RTI~I[~ THAT in the follo~ ng t ~cat o~i ~ B~ent ,. ~ Ist Fl. ~ 2nd FI. Section Bilk Lot FIXTURE OUTLETS ECEPTACLE~' DRYERS FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENTi OTHER DIMMERS SYSTEMS ND. OF FEET OTHER APPARATUS: E R V I C NO, 0$c CC COND PER A.W G NO OF NEUTRALS A W G. NO OF HI-[EG OF HI-LEG OF NEUTRAL P.O,gO× 500 66 OLI) COHV,/'T'RY ROAi'~ ~.~lJ~ '~ 5 ~ O0 GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect, inspector~ may be identified by their C~entials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF cERTIFICATE MUST' NOT,BE ALTERED IN ANY MANNER. F1ELD ~ ........ o~ FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & -FLUMBING e INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIO~A'L COMMENTS INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD ORDER TO REMEDY VIOLATION Date: TO: Joseph Hardy & Wife 1645 North Highway Southampton, N.Y. 11968 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 November 14, 1991 PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance CHAP. 100 Other Applicable Laws, Ordinances or Regulations at premises hereinafter described in that ALTERATIONS WITHOUT A BUILDING PERMIT. In violation of ARTICLE XXVIII SECTION 100-281 OF THE CODE OF THE TOWN OF SOUTHOLD. YOU ARE THEREFORE DIRECTED AND ORDERED TO comply with the law and remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at:13520 MAIN ROAD, MATTITUCK, COUNTY OF SUFFOLK, NEW YORK, SUFFOLK COUNTY TAX MAP ~1000- 114-11-5 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. PLANNING BOARD MEMBERS Bennett Orlowski, Jr,, Chairman George Ritchie Latham, Jr. Richard G. Ward Mark S. McDonald Kenneth L. Edwards Telephone (516) 765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 MEMORANDUM TO: FROM: RE: Gerard P. Goehringer, Chairman Zoning Board of Appeals Bennett Orlowski, Jr.""~'l~ Proposed Site Plan for Hardy Plumbing & Heating S/s/o SR 25 opposite Wickham Avenue, Mattituck, N.Y. SCTM $ 1000-114-11-5 ZBA Appeals No. 3959-SE As Amended on 1-10-91. DATE: October 31, 1991 On OCtober 21, 1991, the Planning Board started the environmental coordination for this project. However, the enclosed memorandum from the Building Department raises some questions which should be answered before the Planning Board proceeds with the environmental and site review. It would be most helpful if your Board could provide a detailed response to the points raised in the attached memorandum that pertain to matters under your jurisdiction, specifically, whether the proposed storage building should be considered a principal use or an accessory use (and structure); whether the third retail business can be issued a Certificate of Occupancy based on the September 12, 1991 decision on Appeal 3959-SE or a prior decision of the Zoning Board; In addition to the questions raised in the attached memorandum, one concern of the Board is that Condition $2 of the decision on Appeal 3959-SE requires the striping of two parallel parking spaces in front of the retail stores. Part of the property in the front yard lies within the right of way for State Route 25. Implementation of this condition will require a coordinated review, environmental and otherwise, with the New York State Department of Transportation. If our past experience INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD TO: FROM: SUBJECT: DATE: PLANNING BOARD VICTOR LESSARD, BUILDING DEPARTMENT ~/ SITE PLAN FOR JOSEPH & BET~Y HARDY OCTOBER 23, 1991 Pre-Co done for Nickolas Kouros on April 10, 1980 indicates property contained a one family dwelling and two (2) retail stores. Action to correct third (3) store required. Violation still exists on conversion of accessory garage to habitable quarters. Application to legalize same has just been denied by Zoning Board of Appeals. Proposed Building of 2400 square feet has insufficient sideyard set-back and requires favorable action from Zoning Board of Appeals to remain. Property's of over 20,000 square feet require a side yard of 5'-0 up to a 39,990 square foot property. ZBA should determine if main or accessory building. Ail these conditions should be addressed before proceeding with the site plan. VL:gar ce to: Zoning Board of Appeals/ OCT 2 3 1 @1 SOUTH, OLD TOWN with the State is any indicator, it will not be possible to obtain State permission to designate parking spaces within the right of way for SR 25. After we have received your response, we will ask the applicant to provide suitably revised site plans. The environmental coordination started on October 21, 1991. However, these questions must be addressed before the Board can reach a determination. Encl. cc: Victor Lessard, Principal Building Inspector APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Charles Grigonis, Jr. Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Telephone (516) 765-1809 . SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 BOARD OF APPEALS TOWN OF SOUTHOLD TO: FROM: DATE: INTER-DEPARTMENTAL MEMORANDUM Bennett Orlowski, Jr., Chairman Southold Town. Planning Board Jerry Goehringer November 18, 1991 SUBJECT: Your Informal Inquiries Received November 1, 1991 Project Reference: Hardy Plumbing & Heating SCTM ~1000-114-11-5 at Main Road, Mattituck Zone District: Hamlet Business (NOTE: This response shall be used in the Matter of Joseph and Betty Hardy at Mattituck, only. Parcel ID ~1000-114-11-5.) Your inquiries concerning the above project have been received. Since its submission, Mrs. Hardy was again today referred to the Appeals Office by both the Building Inspector (Curt Horton) and Planning Board Office (Valerie Scopaz). Mrs. Hardy has not been able to receive answers to the following questions: (a) does she need a building permit to make interior alterations for a proposed third tenant as a Boutique Shop? (b) does she need a Certificate of Occupancy for each new tenant of the front building if the occupancy or use changes? Both her questions and yours will hopefully be answered on the following pages, taking into account the following notations: 1. The proposed building as shown on the August 4, 1989 plan on file with the Planning Board and pending at this time (as prepared by Peconic Surveyors & Engineers, P.C.) was deleted from the Z.B.A. plans as authorized by Mr. Reale, attorney for Mr. and Mrs. Hardy, and therefore was withdrawn from consideration. 2. The maps before you are not appropriate for processing since they do not show the uses as recently approved and Page 2 - November 118, 1991 To: Planning Board Re: Hardy Projec~ at Mattituck Zone Districlt: HB modified by the ZBA. The area shown for retail occupancies do not appear to be i;ncorrect, and the store dimensions and front building setbacks iare believed to be preexisting of zoning. 3. Also to our knlowledge, the nonconforming use of the front yard area for parKing-is also preexisting of the zoning code. 4. The size of this parcel is 21,906 sq. ft. The square footage of the front building has not structurally changed, and is, to our knowledge, validly preexisting. The tenants and occupants of the internal portions of the building have changed several times overi the last 35 years (i.e. retail stores, luncheonette, pizzlaria, personal service shop, business office, and others uses pelrmitted under the code at that time). With reference to iquestion %1 of your memorandum: ir It is aPParent that the proposed building does not! meet the setback requirements of the Code (accessdry or principal). Therefore the site plan should either be revised to delete this storage ibuilding from consideration by the Planning Board, o'r be held in abeyance until such time as the appeal process begins (i.e., the Building InspectOr should issue a Notice of Disapproval a copy of Ithe building permit application was filed with th~ Building Department on April 4, 1989; copy atta~he~ for reference). Each departraent should require las part of their files a construction diagra~ to determine conformity with height provisions of the Cod~. Since a variance is needed for setbacks, we will irequest this information at the time of filing df the variance, if you prefer. Other questions concerning its use, as it relates to the accessory or principal use provisions, should also be asked, i(The building permit and site plan applica- cations!should be revised to include these questions.) 2. Today M~s. Hardy delivered to the Building Department an application for a building permit (copy attached) for minc interior changes to the center store. ~ were required in the pa~t for plaoement~ of oounter~ and the like for ~afety rea~on~ under th~ Constrp.tlon Code. ~A~h~Certrf~ate:.~f~: ~:, Page 3 - November 18, 1991 To: Planning Board Re: Hardy Project at Mattituck Zone District: HB This would help to ~ssnre,~not,~n~.~y:~ :t~.,~:~t,,a,]~o ,NYS Construc~zon ~an~j~ ~.~ca~e ~ules[~ ~ were an increase or expan~~he colOr, iai areas (The Pre-C.O. issued April 10, 1980 indicated that there were retail stores in the front co~ercial building. It also made reference to the n~ber "two," which was for two tenants or occupants within the s~e building complex. The actual floor area of the stores have not increased since 1957 to the best of our knowledge. And we all know that zoning may not be used to control ownership or tenancies. ) 3. Your last question concerns the painting of two parallel parking spaces in front the commercial building. In speaking with A1 Bachman, Engineer with the NYS Department of Transportation, it is his opinion that if the elimination of diagonal parking were agreeable by the owner, the NYS DOT would not be disagreeable since it would be an improvement. Mr. Bachman suggested that a copy of our decision, together with the map existing parking area be referred to the NYS Department of Transportation. (Alternatively, in the worst case scenario, the DOT would, of course, supercede the Planning Board or any other town ~gency.) Please keep in mind that the existing diagonal parking has been in existence for over 35 years, and with the owners' consent, will be improved by the elimination of backing-out onto the highway (at the least). To summarize the above, this project will: a) require amended site plans maps (should not affect SEQRA) b) require compliance of the "accessory building" which was improperly converted over the years c) require a variance as to setbacks of the proposed storage building d) require a referral by the Building Inspector to the NYS DOT pursuant to General Municipal Law, Section 239K e) require a Certificate of Occupancy in the name of the new tenant or occupancy for each unit in the commercial building certifying the use and any building alterations f) not be permitted to expand or increase the commercial building floor area in the future (unless variances are obtained) g) require a Certificate of Occupancy for the two-family dwelling, after compliance with the conditions imposed under Z.B.A. Appl. Nos. 3958 and 2959 dated September 12, 1991 h) require a Certificate of Occupancy for the existing accessory building, after removal of the kitchen and dwelling facilities Page 4 - Novemberil8, 1991 To: Planning Board Re: Hardy ProjeCt at Mattituck Zone DistriQt: HB i) be subject to a determination by the Building Inspector as to the requirement for a building permit under the NYS Construction Codeiand other laws for any and all occupancies of the buildings. ~ GG:lk INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building l~pector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Five Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD ORDER TO REMEDY VIOLATION SCOTT L. HARRIS, Supexvisot Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Date: November 14, 1991 TO: Joseph Hardy & Wife 1645 North Highway Southampton, N.Y. 11968 PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance - CHAP. 100 Other Applicable Laws, Ordinances or Regulations at premises hereinafter described in that ALTERATIONS WITHOUT A BUILDING PER~IT. In violation of ARTICLE XXVIII SECTION 100-281 OF THE CODE OF THE TOWN OF SOUTHOLD. YOU ARE THEREFORE DIRECTED AND ORDERED TO comply with the law and remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at:13520 MAIN ROAD, MATTITUCK, COUNTY OF SUFFOLK, NEW YORK, SUFFOLK COUNTY TAX MAP #1000- 114-11-5 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOARD OF HEALTH SEPTIC FORH ........... ' '° ~ TEL.: 765-1802 t:OTl F'! l / _ ...z ................. e. xan'dned Z/,~ 19 c;~/ ..... - · ''~' ........... , ..' , , ri^ ,t i. ~"O: ,:pproved ........ 19.7.,Z. I'd'Il ................ ." ~' (Building Inspector) . APPLICATION FOR BUILDING PERMIT Date .... Ii.//. ........ 19q./ INSTRUCTIONS (Name and title of corporate officer) Builder's License No ........ : ................. Plumber's License No ........ '. ................ Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. a. This application must be completely filled in by typewriter oi in ink and submitted to the Building Inspector, with 3 ,ets of plans accurote 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 4;r[ation.areas, and giving a detailed description of layout of property must be drawn on tile diagram which is part of this appli- c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit .ball be kept on the premises avai/able 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 · hall hay6 been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or {egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. I-he applicant agrees to comply with ali applicable laws ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspections. __ ,.-"'"'-h .... · ( ig~nature of applicant, o~ name, if (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ..................................................... . ........................ ' Name of ownerofpremises ..Jo.$~P~.~ (as on the tw.x roll or latest deed) It' applicant is a corporation signature of duly authorized officer. I louse Number Street Hamlqt Cotmty Tax Map No. 1000 Section ......... ~./..q ...... Block ...... Lt ..... Lot... Subdivision ..................................... Filed Map No. (Name) .............. Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex:sting use and occupancy . . .'JT.~.'rT.O~.. J4$11kl~,5~ ............. ,., z .' ...... ..' .... ................... b. Intended use and occupancy . .S.-ro.~ ~: .... -~o~..'T-?~?gt.~:. ~ -:.": ~ , · , 3. Nature of work (check which hpplicable): New Building .......... Addition .......... Altei'ation ....~..... Repair ........... · · · Removal .............. Demolition Other Work ........ 4. Estimated Cost .~..O~.! t~' 't~,..~.~. (Description) $. If dwelling, number of dweIlin~ units...'~.. '" (to be paid on filing this application) · If garage, number of cars .~T..-F.. · ........ Number of dwelling units on each floor ................ · ~ us c,xl~ung structures, a a-r/y'~Fr0nt ;.~ ~ - ....... '~ ...... Dtmensmns of same structure with alterations o~ ad, it ,~-. p~' ' .' ....................................... : ., ...... ~. trent .... Rear . . 8. Dimensions of entire flew ~onstmction Front, '..' r Hei- ~ .. ............... ~" ~ ....... Rear .... 10. - ................... Depth .. ..................... Date of Purchase ..... /'~ ~i .......... ' .... ' .....Name of Former Owner . l I. Zone or use district in which premises are situated .... ~.1~ Q~I'~/~A~"~' ' ~'~/~/~" ........ 12. Des proposed construction vidlate any zoning law or ' D ' 13. Will lot be regraded /[,/O ! . , d~n,~,n.,c,e or regulafion: ./5/rD .............. ...... ~ ..... .. ........... wm excess fill be removed from premises: Yes 14. Name of Owner of premises .d.q~gP. pr, ~l~h.~ .... Address ;,~.~ ~ t4 . Name of Architect ..'~.. ~ i · ].~ [~..D.~.~b,. PhoneNo 15. Ia th~s property w~th~n 300 feet of a tzdal wetland? *Yes ........ No.~. ..... · If yes, Southold ~own Trustees Permit may be required, .... PLOT DIAG RA/Vl Locate clearly and distinctly all! buildin,~ w · . , ,,~, hether existing or proposed, an&indicate all set-back dimensions from property l/nes. Gwe street and block humber or descriptioh according to deed, and show street names and indicate whether interior or coruer lot f, lfP~· ~:KI~[~NG OEPART~AT '~;f,-~,' 9 AM TO 4 PM FOR THE FOLLOWING ~. FOUNDATKJN - '~0 REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSU~TION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR AL[ CONSTRUCTION SHALL THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ION · ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR CONSTRU~ON ERRORS TATEOF~, .?~F-~Tp /[/ s'$ . ou,,¢r¥ OF -'i -- .......... ,~'..~..~.....4 .... 9/.~..~..~.'-: .~. ...........being duly sworn, deposes and says that he is the applicant (Name ofin~lividual signin~ contract) )eve named, i (Contractor, agent, corporate officer, etc.) i . said owner or Owners, and is duly Rut mnzed to perform or have perfonfied the said work ~nd to make and file this plication; that ail statements contained in this application are true to the best of his knowledge and belief; and that the ~rk will be perfo~ed in the m~ner s~t forth in the application filed therewith. 'om to before me this ............ .............. N~ ~bllo, Stateiof m~Yo~ No. 4879505 ~ ~- · .~ ~r:~. . ~mmls,ion Expire, De~m~ 8, 1~-- C ..... ~ ap;Jcant) /'