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Home My WebLink About19027-z FORN NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20171 Date AUGUST 27, 1991 THIS CERTIFIES that the building ADDITION Location of Property 725 SHIPYARD LANE EAST MARION, N•Y. House No. Street Hamlet County Tax Map No. ].000 Section 38 Block 1 Lot 7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 11, 1990 pursuant to which Building Permit No. 19027-Z dated MAY 17 1990 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to HEATHER S. TAYLOR (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-183420 - APRIL 16 1991 PLUMBERS CERTIFICATION DATED AUG. 12, 1991 - K&K PLUMBING Building Inspector Rev. 1j81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector down Hail Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20179 Date AUGUST 27, 1991 THIS CERTIFIES that the building ACCESSORY Location of Property 725 SHIPYARD LANE EAST MARION, N.Y. / House No. Street Hamlet County Tax Map No. 1000 Section 38 Block 1 Lot 7 Subdivision Filed Map No. Lot No._ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 11, 1990 pursuant to which Building Permit No. 19027-Z dated MAY 17 1990 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 BUILDING IN REAR YARD AS APPLIED FOR. The certificate is issued to HEATHER S. TAYLOR (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. NfA PLUMBERS CERTIFICATION DATED N/A ~~v Building Inspector Rev. 1/$1 ao;s~ xo. s TOWN OP SOU7'HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERAAIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF 7HE WORK AUTHORIZED) N i ~ U Z % Z Date «x...1.7..............., 19.9.E Permission is hereby granted 4a: ...h!...?:«:?~...... ~.~a.~s.....1.`?.`~ w~".....~..:~..~......1.1.4.'~ y.. at premises located at .7a'.~......°':"`~-L!~r`~......0!4'.4:">'!............:~!!-~~:...~4Rle~J............ : County Tax Mop No. 1000 Section ......S~.iti,~....... Block .......Q~......... Lot No.....4...~ Pursuant to application dated 19.R~?.., and approved by the Building Inspector. v Fee . Building Inspector Rev. b/30/80 f , Form No. (r L5 U ~ ~ [ y4 ~ TOb1N OP SOUTIIOLD d~~~j y"~~~~ ~ BUILDING DGPARTPIGNT ~ ?i; f~ Q ~ TowN BALL ~ AllG 161991 , 7fi 5-1802 _ tii[, ~"i ~ APPLICATION POR CGRTLFICATG OF~tOCCUPANCY I. This application must be filled in by typewriter OF .ink and submitted Co the building inspector with the fallowing: for new building or neco use: 1. Final survey of property with accurate locaCion of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Deft, of water supply and sewerage-disposal (S-O form). 3. approval of elecCrical instal-lotion from Board of Fire Underwriters. . 4. Sworn statement from plumber certifying that the solder used in system contains less than 2J10 of 17 lead, S. Commercial building, industrial building, multiple residences and similar buildings ' and installations, a certificate of Code G:mpliance from archi'_ect or engineer responsible for the building. 6, Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior [o April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property stioeainr, all property lines, streets, building and unusual natural or toQaFraphic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, Che Cuilding Inspector shall stage the reasons therefor in writing to the applicant. Fees ' 1. Certificate of~Occupancy - New dwelling $25.00, Additions to dwelling $25.00, A1Cerations 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 Builcing - $100.00 0. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ~ Date .G,%.~:.l.~.l.~.~/ Construction........... Old Or Pre-existing Building xation of Property.7.~s.........J~,~;4.IS~,~IR.R.J.~.AN.~-.,.......... C-. t:~~:r?;~,gru......... IIouse No, Stree`t/ Hamlet }wer or Owners of Property...1~.~,IJ,T~.~.~..r~.:..~.~,+.41r~?f~`~ unty Tax Pfap No 1000, Section...~.~.....,Bluclc.....1:. .......Lot division......"q . . ....g....t. Fil/egdp~tci{r........ , ...Lot~.[......~.~j,~.( :mit ::o...~.~~f-37 Z...Date Of Permit.M/~~.`~fl~.l./N..Applicant..11.~.e~..1C).1.~~... ~lth Dcpt, Approval ..........................Ur~dcrwriters Approval.,~,~.4.~ Inning Board Approval :uest for: Temporary Certificate........... Fin.il Certicate.., v...... . SU b::11tCCd: ~ ~ ~ap~~' - nrrLlcanT ~ Forrn No. r, ~ I~~~ )7r~ TOIJN OP SOUTIIOLD ~•r / / BUILDING DGPARTPIENT i To1•IN HALL 1 ~ 1991 ; 765-1802 E;~~1 / q i r TONI~! aF SOUTWCi-;~~..,n-.~~! APPLICATION I'OR CERTIFICATE oP OCCUPANCY This application must be filled in by typewriter OP, inlc and submitted to the building inspector with the following: for new building or neca 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 17 lead. S. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Cranpliance from archi.ect or engineer responsible for the building. ' 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) vion-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 DuildinS Inspector shall state the reasons therefor in writing to the applicant. Fees ' 1. Certificate of Occupancy - Neor dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool 525.00, Accessory building $25.00, Additions to accessory building $2~.D0. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - 55.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $SO.OO 5. Temporary'CertiEicate of Occupancy - Residential $15.00, Com`mqerqc~i/al $15.00 ~.C~t.-ty~'rte Date ~~f.l.<.lj/ ew Construction........... Old Or Pre-existing Building.,,• ? . ocation of Property..7~~......~~C) ~flt~~.,~.-Z4u~-r...........~.•.~~~'l.~lY............ " Ilousc No, Street Hamlet twcr or Owners of Property... ~..f.{:oo~~r..~a..:.Ta:=1~! 1.02 aunty Tax Plap No 1000, Scction...'.~`'.~? .......Bluck...~..:....,,,..Lot bd ivision Filedr~~4ap ,.~./Lot.~.-.(~.[~./~j........../.~1.. . :mit ivo..t94.;'~~Z....DaCe OC Permi.t.lt~.{.6~r~CI.11l.Applicant.. JY-~114``k.GG1Cr...~^~~W~ ~lth Dept. Approval ..........................Underwriters Approval.,,~1.1.).0.J. L1 Inning Board Approval :,uest for: Temporary Certificate........... Final Curticate.., Submitted: a~ ~s _ ~~~-Pte.-.~.......... ~,Q~aO ~ l APPLIC,NT ' ~ ~ ~~~~OU,~~, TEL. 7~s-I aoa ~o o~, mown or soUTHOa,D ~ < OFFICE OF BUILDIt~1G INSPECTOR ? i ~ P.O. BOX 728 ~ SOUTHULD, N.Y. 11971 ~~~~1 ~ Yob C E R T I F I C A T I O N f~ I 1 ' 4 Date O' `~1 I r Building Permit No. ~ a~ "Z, Owner_ ~e~~2t' ~G~tCC ~l(please print) \ Plutnher F- ~ ~ m~~ O~c~ ~'~20~~~e (please print) 1 L«~e 2.35~_~ I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. ~A~~~ ~ ` (plumber's signature) 5worn,lto beforn_ me this day of C U~, 19 ~ ~ Notary Public ttotar! Pubh,ic, ~ Caunty MMMI ~ 11 I ~ o ~ ~ - - y r _ FOUI~DA_TION y/// (1st J .~r~~~' FOUNDATIOtd (2nd1 M i z 2. / ~ P,OUGH FRAME 8~ PLUMBING ~ ~ °'S" H N~ a _ ~ 3. ~ IIdSULATIOPI PER N. Y. ~ , STATE ENERGY CDDE ~i~~ 030 ,d'~, ~ r 4 . / / I _ y i~ FINAL ,,...C o~ ADDITIONAL COMMENTS: ` m B @ . Lsry ~ x ro r+ :a a • H N w O 2 T [*1 y C ~ - ~ m • •o ~ H I ~~~a~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INS TION [ 7 FRAMING FINAL REMARKS: --~F-!~ DATE INSPECTOR ~"`y` ~ 765-1802 ' BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ }FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: DATE ~ INSPECTOR /~a2 ~ rss-isoa BUILDING DEPT, INSPECTION [ ] FOMNI~ATION 1ST ROIJGW PLBG. [ ] F TION aND [~]~11~SULATION [ l ~G [)FINAL D . . DATE a ~ INSPECTOR L l to 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION i5T [vJ" ROUGH PLBG. ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ ~P t I i t i ~ r i' DATE ~ INSPECTOR i ~ ~o~-~ 7ss-1802 BUILDING DEPT. INSPECTIt?N [ ]FOUNDATION 1ST [ ] ROUGH PLBG. ()FOUNDATION ZND [ INSULATION (]FRAMING [ ]FINAL C-~. REMARKS: c~-~, _ `f ~ DATE l ~ ~ INSPECTOR , 765-1802 BUILDING DEPT. INSPECTION [ ]~~~~TION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ ~ DATE 7 ~ INSPECTOR 1~ ~ '765-1802 / BUILDING DEPT. 1 NSPECTtON [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION ~RAMING ( ]FINAL. REMARKS: c`.~ 6' , DATE ~ ~ INSPECTOR ~.e~ ! ar ~ kkrr , : r ' r . ~x,, ~ ~ r ~ °'F '-ANDRAOE V ~E ~ ~zt:• 'R~f-r O ~ j v 'p , 1n • fx.;r° 1 ' 0 7 r n\ N . ~ T ? --`f.5'O.O f ~ ~ ul~ ,F;'N.'ZOUVES . ~ ~ ~ ~ ~ h v ~ i :'M •i[ N p ~ ~ ~r .•.~z,~+ foot-r1nM1 n c!'Y:ah ' ~ t'.; ~ f.....„ i• r r..'...;n~ M . a. ~ • i;tl)bOP n'} t{M S1 iM! 10... $fdiC '""rJCUfiCn taw• • Ca~`.En c1 +h'2 „uv r mup ant hzrm4 . , . ;hp It.u: cunbvor't uA^U aCal a s, ` ~ Lrna`-^•-+: s001 shun ro: ba cnnaidornS ° - IO bn d YEbd tru0 caOY• ' 6Y1 , r: nalbnif3a iPdlf.8t9d hafnLn LhJll f:in ~8! 40 Ih0 OvraOO Im whom th0 : GO/O} , ~ lr nrbu2le-• and On h!s benf;i t0 uu. - c . , , o:•ernmo .;;1 c^f.oy a: 0 fl•': fa: - i'',t L'~)3 ftn n'JCnY.4 gla: s~, .MAP OF P/ZQPERTY H~~:-.,, *Awvun l.ctad h~;con c...l ' ~ SL/RtVEl'El7 FO to US ~Lra2n.~oa at ffo W..S.~,;, i:r.;J-. f'l m;1oa. 2.. c; i• a.ca r.: a not :,ns•~ unni ~'7 ~j ^ , f41.=si:~07ci InsutuUOns or tubsb~~ A T :'1 pF Ncw r' . .EAST" N(Af2lON ~ . Y• A 0,9 ~ ~ ~ I~Q pGn nt~? rc `5}~'~~~ ~ ¢ ~1j..t Ep ~ • . - . n 20 0 ~ ~tia<'•~IaNO%~~ Gus~~'ANTECl3 T'07'HE /NTER-000NT _ _ TITLE GUARAAITY~ MOR7'GAG~ CP. ,qNp NOR7'h/ F"OR/< LANK ~ TRUST" CO. . ,~s sul~v~-Y~p ocr.2g,l9G~ _ `.r'GALE ; 11.4'~/'~ OT7-/p~f,,W. ~/AN TLJYL. ~ SON . rl'r'L~'No 9-I,S'4~6 ~-/~ENSEb 1,AlVIa~~YORS f'RE~NF'ORT NSW YORK _ _ : a„, TEL. 76S-18Q2 S~~~OU(C TO'4~N 0~ 50YJTHOd,D F Q ~ OFFICE OF I3UILDI)QG INSPECTOR ~ P.O. BOX 728 ' y~ ~ ~ T01VN HALL O~'~l ~ ~b~~ SOUTHULD, N.Y. 11971 ~=,i ~I C E R T I F I CAT I O N Date ~~y t~~~ ' buildings `permit No. Owner tea:^o~d'~ ~~-~-~~Ur (please print) Plumber ~u7r~^~t~k~ ~ (please print) , I certify that the solder used in the water supply systom contains less than 2/1Q of 1$ lead.. „ ' ~ _ ` (plumber's signature) Sworn to befor^ me this ~ ~~y day of r 19~, Notary Public tlotar,• PubL~io, t F County ~ ERIC Q. KOCH , Notary Pubik, State of New York QiM11fl k1$utfotk~Coumy YOfl11 E7ipkp Janltary St 1892. , ~ ~ l ~ ~ 3~, ~ p•~d~ ~ ~ ~ ~ C ~2yN(o w k , _ SbC~ ~u t t~ r.-. ti aoWP~tub~t,~~~~ttnt~ j~ v ~ ~ {or water matt ~ i _ w. of spas l !p ~ `At ~~v ~ - ~~r.~ ~ ,s ~ - ~ _ _ . i ca t~1 PLUMBER CERTIFlCAT/ON ON LEAD CONTENT BEFORE CERT/FJCATE QF OCCUPANCY SOLDER USED !N WATER SUPPLY SYSTEM CANNOT EXCEED 2110 of 1 % LEAD ~ n W.a ' ,r'+`t L f Jr' ~ Af Y r r. M~. ^ n 1 4' .-.~..q _ ry' - iY Av K~ : i j ~ k ~ \ ~ 5 9 ~t .1 /j~ " . ~ r*VI~.k .p _ v v f 1 L1~~!! `L ' E t M1 ~'iJ i W ~ ~ ;{Z rt r ~ ~ V Y ~ } ~ w~ : ~ < ~ .tr ttir~+ ;Qu a O ,t,~ ~ ~ ~ ~ 4 ~ • • a° ~ '~F'~,,,~c ~ t' ~ ~ ~ N ' d~ 41 _ N• s `2 ~•q %'r ~ ' a ~ t • ~ S'. ~'•m.-..a nn<r-^.'nn nr N.-"t3Jp A~.gron a; thA H;w 1'o.'.c b'(a:t "Aecetion law. y ' ' , ~ ikNiss of thi:.rxww7 mrvr not M_uinq . ' ~ - :>k: J@.H: Gkm'AyAr a In<n6 5C3i J, i ['e"~a ~ v'^r.:Y:P9n Sbnl SFb4: nJ4 (1b CO[ISIQO(Clt ' ~ [o bb E v[fltl iruo bopY~ • - Cueren;ene Indicat=C hstt+cn ,hall ron ' fi 4 ~ cn1y to tho person for warm :no %+.rro'_ ry~j. t " M A (•j l; iN'GUaf'- 0na On hi3 boil&~( to Li3. . P+C'QPERTY (•!)p COb+:._n'l. Ap•atOrnU1.3(C'?f:%R..^.If~ _ SLJIri'V~ y~~rl7 „ ~wdn., .:r;nutton l:ccaa garcon m..~„~ . 1 r: o,~ is ihS C': ~'~tADY at ci:a 1U...S:n;, 16:1:! x, ibUan. c~G: r,. dG.^S Me nai 4'cn3rvrbb~9 //''~/~-y ~ ! to ac~i,laoc; irtsiliufipn8 ar subHb'queRi - NEw , • , . rt A'7" tiP ~a r~ fi . , - N. y, N do a~bq ni.cx ~ I " '~~k'ff: a ~ r 'I;tN-~~ ~o . ~FytiO~ ~s 5~`~J~~ l.7 LAN~~'--' '_r • - GO~~'Aw~-ECr~ ro 7`H~ rNr~~-cou~i'r,-; TITL...E ~ ~QRANTY~ IrtQl~'7`GAGfi' CP. AAtp NO/~ 7"t SCA1.~•: ¢O'r/.. AS .51,/Fc'VE'Y~,-pANK ~ TRUST" CQ. ` MON: OrTp W. VqN 7"UYL ~'f>l4ts ~ ~ ~ ~ saM T'lT(-,E`Nd..S~r/S9't'~'6 /-rCENS~~ .LA/V~f~~SU ' `~%,..'~M~'ii„.,:..w.. .,.....~..t'FL~ NF''C]IZT . NSW' RV y YOl2h . '..nom. ..Tr~u.~_' ' BOr1RD OF HEALTH 3 SETS OF ANS FORM NO. 1 SURVEY ~ . TOWN OF SOUTHOLD CHECK ~ ~C~D. • , • , , , , , BUILDING DEPARTMENT SEPTIC FORM TOWN HALL ~J~J~/ !~P~Cj $OUTEOLD05- 8021971 NOCALL ~.-ll.G . ~~~1., 199V MAIL T0 . Examined (J Approved ~ 1980. Permit No. 9 0 l~ . Disapproved arc . ..................................'1..r s.~t.u•4 . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 15 . INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~ 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 Reculations, for the construction of buildings, additions or alterations, or for iemoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housinti code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp~~,e,~~~~ns. (Signature of applicant, or na , if a corporatton) (Mailing address o applicant) State whether applIlic~~ant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Y . Name of owner of premises . t. i, ~l, ~ .~`...~-~.f (.~.`~L: (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. ~ ~1r9+~?!~..~(.X-? . Electrician's License No. ~ Ot1te[Trade's Licr~nse No . . 1. Location of land on which proposed work will be done; I[ouse Number Street, Hamlet County Tax Dlap No. 1000 Section Block Lot w:.. Subdivision Filed Rlap No. Lot . •(Namej State existing use and occupancy of premtses a~~n~~^d intended use and occupancy of proposed construction: A. Existing use and occupancy... ~1.~~-.. 1`: ~ t ~l/ • • • • • • • • B. Intended use and occupancy....~~t~•~::•~~•1•~•~•~,?~p -u '"f .-,e 3. Nature of work (check which applicable): New Building Addition Alteration . Re air . RCmaval Dc~nolition ..............Swimming pool . Tennis~Court Accessory Building,~C ......Felice .......Other Work............ 4. Estimated Cost ~ ~ ~QQ Fee . (to be paid on filing this application] S. 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, spe~~ure and extent of each type of use , . 7• Dimensions of existing structures, if any: Front . ~ Rear Depth . . Hei;ltt Number of Stories ~ ,;j................ . . Dimensions of same structure with', altcrat}ons or additions: Front . ~.~r Rear . . . Depth Iicight Number of Stories . 8. Dimensions of entire new constntction: Front . Rear ...............Depth . Height . dumber of Stories . 9. Size of lot: Front ...?ate ~ Reaz , ~ Depth . ! :~~J 10. Date of Purchase , ~ ~ ~.r~ .Name of Former Owner . . 1 1. Zone or use district in which premises, are situated ..F~.. v • • • • • • • • • • • • • • • • • • • • • 12. goes proposed construction violate any zoning law, ordinance or regulation: ~ • • • • • • • ]3. Hill tot be re;raded Will excess fill be removed from premises: Yes No . . 14. Name of Owner of premises ~~=!`~'m.~~~.:S •.~x~4r~}ddress Phone No. ~.7~.:~~• . Name of Architect .....Address ...................Phone No. y.. Name of Contractor .Z?4~!/.~~!hl~ . Fem. ...Address ..Phone No. ~}7~ : •7 IS.Is this property located within I00 feet of a tidal wetland? *YES....NO~.. *If yes, Southold TownlTrustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly all buildings, whether existing or proposed, and indicate all setback 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. STATE OF NE\V YORK, S.S COUNTY OF ..1•'}k./.~.TH~~.-•-'r.'. • f~~~IG"~'.~~..' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) about named. Hcisthe (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed flit said work and to make and file this application; that all statements codtained in this application arc true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. , Sworn to befor//e me this ........4~ . ......day of 19 .r^.~ Notary Public, County 1. 111i~~., ~~7~e ~~¢_S$p!!q~d~N~W11bNR, • ~ ( nature of applicant)