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HomeMy WebLinkAbout18393-z ' FORM NO. 4 r TOWN OF SOUTHOLD BUILDING DEPARTMENT , Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20200 Date SEPTEMBER 9, 1991 THIS CERTIFIES that the building ADDITION Location of Property 1640 FIRST STREET NEW SUFFOLK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 5 Lot 46.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 2, 1989 pursuant to which Building Permit No. 18393-Z dated AUGUST 16 1989 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 GERARD H. & CAROLYN M. SCHULTHEIS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-024080 - AUGUST 28 1991 PLUMBERS CERTIFICATION DATED N/A ul~ ~ B ilding Inspector Rev. 1/81 poaas xa s y 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) N°- 18393 Z Date ....~1./..~ 19`.'./.. Permission is hereby granted to: .....~9~.. to . . ..,,,~..~~5.... ..Ir.!-L~ at premises located at ...~1~7..~.....,~ ~ ..................................................5,, ..7...~ic~~,~......~,3.~ ...~...........l..a..-t~.7...-..~3z~3................. County Tox Map No. 1000 Section Block Lot Na.......~.e7.~..~.. pursuant to application doted .....Q.~?" 19..c~...gand approved by the Building Inspector. Fee . uildi Inspector Rev. 6/30/80 /6Y0 f``- , Form No. 6 ~ ~ ~~..~-W ~5 ~ ~__,I.I~~1.~; TOWN OF SOUTHOLD yJ 7/ ~7f1S/ AUG 151991 , ~ BUILDING DEPARTMENT 3° TOWN HALL „,,,~„,yt~::~' ~ 765-1802 6LGG. UENT'. .f,,,m.µ.~ TOWN OF 501JTF90Lt7 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 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 ly 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 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 Building - $100.00 3. 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 $1ff5~.j00, Commercial $15.00 Date . S/. l.~ New Construction.... Old O1r Pre-existing Building. Location of Property. ~ E? ..l .'.nsT.......5~ .............NQw Sv~cFu~~........................ House No. Street Hamlet J L~ Onwer or Owners of Property.l~:':'?~`.lC.£~4~~r~..:?~."I~he" tr-- County Tax Map No 1000, Section...I,~,~,,,,,,,,Block.....~./..........Lot...~~,a~ Subdivision..(())...pp ...............................Filed Map............Lot..(.~.......f............ Permit No..I v~43~.....Date Of Permit.l~/~6~.~~......Applicant.~~:'?'~. J7: ~4~:1:+.~~`?....... Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate...Y....... Fee Submitted: ~ U ('0,~~`' O!100 APPLICANT ~ T__ ~ _ _ THE NEW YORK BOARD OF FI12E UNDERWRITERS NAGF: AOd70'~i BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK. NEW YORK k}0~038 Date AUGUST i8, 1993. gpplicetionNo.onJik 66106989/8) H 0290A0 THIS CERTIFIES THAT only the ekKrtrkal equipment as described 6sbw and ineroduced by the applicant Fsatrted on the abode applfatien number in the premises of 's GI;RAkD R. SCHUI,TRRS, 3.690 FCkST g1'kEPT, NFM SUFPUf,K, N.. 'E UfIT 'e_ in theJolbtrinp locatio gg t ~ /at FI. ? Ynd Fl. .Section Black Lot AiJ~1J5~3.2~~~ cede a:amined an and found to be in compliance with the reyuirementa of thin Boord. pXTIW RXTURES RANOK COOKING DECKS OVENS DISH WASNHS lXNAUST FANS _ WTLETF ACEES SWITCHES INCANDESCENT FIUpIESCENT OTHER NAT. K.W. AMT. K: W. AMt. K.W. AMT. K.W. AMT. N.I. 3 7.4 8 3 ~ r DRYERS RJRNAC! MOTORS RIriRE A17DANCE /NDlRS SNKAAI R!C'/T TIME DOCKS EHl IKIIT NEATEK MUlll-0UTIET DIMMERS AMT. K. W, pl N. I. GAS N. I. AMT. NO. A W. G. AMT.. AMP. AMT. AMTS. TRANS. AMi. N. R~T~S AMT. WA115 NO. a 19T .:y SlRVICTE DISCONNECT NO.OE S E R V 1 C E - : 3 AMT. NN. IYPF ~ 1 / PN t / ]N' ] R ]W 3.e AW NR 1COND. a CC. OND. NO. p NI-lEG OF~ WIEG NP.Of NEUitAlS ~ ~~~~Yl - s OTHER AMARATUS. r - Z %ff GRRARD H. SCHUI,TERS 9.3 f1ARDING RUAI) _ OLA GRFFNi1ICff, CT, 06870 p~µ ~Ap~ 3.7 Per ~Y - This certificate must not be altered in any manner; return to tM office of the Eoard if incorrect. ~Jmpectors moy. bs ideMdrod by their cndantials. COPY FOR BUILDING DEPARTMBIT. THIS C©P1f OF CERTtFIGATE ANJSfi NpT?~E ALTERED IN ANY MANiER. -1ELD IGS:'EC:iU7 ~~Un.E COMMENTS _ ! 1 . ~ ~ r\~.(J~ . ~ _ H W~ »OU27DATION (1st) - ~ a FOUNDATIOtJ ( 2nd ) cn 2. o ROUGH FRAME & PLUMBING ti 3. ~ z m ra 211SULATIOPI PER N. Y. STATE ENERGY CODE . x a FIidAL z ADDITIOP7AL COMMENTS: r c» • ~ ~ ' ~ x ro A\ A r ` . _ y ` x . ry . m -o H --~-t.~ ,~SUF~~t~~© ~c>'`~ s~;~ ~ HENRY P, SMITH, President ~ ~C JOHN M. BT2EDEMEYER, Vice-Pres. ~ ~i TELSrxoNE PHILLIP J. GOUBEAUD - ~ (516) 765-1892 ELLEN MKLARSEN JR t~~ ~1~®~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 1 1971 October 30, 1987 Mr. Glenn Just Land Use Company Route 25 A Box 2521 Wading River, New York 11792 Re: Application No. 566 Dear Mr. Just: The following action was taken by the Board of Town Trustees during their regular meeting held on October 29, 1987 regarding the above matter. VdHEREAS, The Land Use Company on behalf of Gerard H. Schultheis applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated August 4, 1987, and WHEREAS said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a public hearing was held by the Town Trustees with respect to said application on October 29, 1987 at which time all interested persons were given an opportunity to be heard, and WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW, THEREFORE, BE IT RESOLVED that The Land Use Company on behalf of Gerald Schultheis BE AND HEREBY IS GRANTED PERMISSION UNDER THE PROVISIOiVS OF THE WETLAND ORDINANCE OF THE TOWN OF SOUTHOLD TO: To reconstruct within 18" approx. 245' of bulkhead and to backfill with 80 cu. yds. of trucked in sand, to construct a 3'x12' ramp, 4' x 36' float, dredge a 10' x 30' area to 4' at mlw and to construct an addition to the existing house and to extend the deck to the north by 6'4" and to construct a 13' return on the bulkhead. APPROVAL IS AS FOLLOLVS: To construct the bulkhead 18" in front of the existing except the 40' section, which is to be replaced in place. The applicant is to speak to the owner of the underwater land in regard to the placement of the dock. A letter is to be sent Board,~+-Trustees -Page 2. Gerard H. Schultheis To the D.E.C. in support of the dredgin to a depth of 8 ft., Schoolhouse Creek, N.S. This permit will expire on October 29, 1~7 if work has the Trusteese areyto be not fiedTupon the completpion of theework d and Prior to the issuance of said permit by the Clerk, the applicant shall file with the Clerk a certificate that he has public liability insurance policies insuring against any liability which may arise in the performance of the operations pursuant to such permit in such amount as shall be fixed by the Trustees, which said policies shall name the Town as a name insured. Please take further notice that this declaration should not be considered a determination made for any other department or agency which may also have an application pending for the same or similar project. 4Ve advise that ou contact the Coast Guard if ou lan to do the work from the water side. Please be advised that there is a 10.00 Wetland Inspection fee due for this permit . Please return to the Building Dept. for a determination on the need of any other town permits that may be required for this project. Very truly yours, d ~~~~yuGJ7~ Henry P. Smith, President Board of Town Tru stees i HPS:ip cc: Commissioner Thomas C. Jorling, D.E.C., Albany Robert A. Greene, D.E.C., Stony Brook Stephen Mars, Army Corps of Engineers Thomas Hart, Coastal Management John Holzapfel, Chairman, Southold Town C.A.C. Victor Lessard, Admin. , Building Dept. Planning Board Board of Appeals file 'i I ~ ~ ~~~J 765-1802 BUILDING DEPT. iNSPECT~oN [~NDATION 1ST RO f 7 UGH PLBG. [ FOUNDATION 2ND [ )INSULATION [)FRAMING [ ]FINAL REMARKS: ~z~,//A ' - -!~.~C DATE 0 INSPECTOR G-~ ~ ~ S~~~ I l 6 4v ~„~a- s-~ P~° d~x Z~~ N~ ~i~ ~ ~ ~j ~uv~e 2~ f q~ W I H ~ e 1 S J M s. 'Ze r„ T I ~ ~ Imo. / ( f f k / v~ V w- / ~ c ~v y a ~ r Goy S ~ eke,-r~- ~ f ~~i/~ l ~ 99 6~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REM KS: DATE ~ INSPECTOR ~/~/9` G~ ~I, 5~~~ i-~~~ to W~ 5~~~~~id ~~w ~ ~~~,.-I I ~ o la N `l. I I `17 ~ ~ ~~,'a 2e ~ sa M s . Ze T w~v~o~ I ~ ~I~ ~ ~ Iw ~ ~3 ' U ~ ~ u r~v n ~'~('/~77 ~ 'r ~j ~ D u 'T G~ l7 i~ w1~K ~ S ~ ~ / ~ ~ C w,.~y ~0 ~ 765-182 BUILDING DEPT. INSPECTION [)FOUNDATION 1ST f 7 1ROUGH PLBG. ( )/F~O~UNDATION 2ND [ ]INSULATION FRAMING (]FINAL REMARK/S-:, ~ ~ DATE i I ~ INSPECTOR Nye I Cam' TOWN OF SOUTHOLD ~ BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK WE7LAN~ ~T according to ranted by the Town Trustees Land Use Col??X??:11Y..for 439 has been g This Wetlands Permit No............ 566 filed by Applicant ~ oocation No• ' I information furnished in AP. ,a„$?,••° A man of thn proposed work will be kEpt I{ Gerard.. „S,chtxlthe}fin , pu~;ust,,,~.,....-.... I under the application number given. 'trustee Office on file in the ~ u a „rox....z&5...A~ To reconstruct,w}thin„18,,,,..R1~ Permit granted to do the following work , ds. , of•,trucked, in„sane}a..:~R..~R1zstS.ucT...a....... u " bulkhead and to backfill with 80 cu to„~.on.str ct i x 30' area 3' by 12...ramp.:..4~..X...~'.b~..float:..aredge•a•1........... Schoolhouse Creeks„New,,,s~.ltf~Atk•••""'""""•'•~ Location of property on which WOrk to be done .....................••NeW Suffolk ) Street, • r.o.w. off of Orchard• (street address New'Suffolk................................. Creek. Schoolhouse•.• or Harbor fronting property Creek, gay ~ and,•ex„t~~4~.... .....R....~4..k1 }7.5. ~..2 4, 6.......... 'L45' of bulkhead:..6.4.. ~ ~ 1, Size of work: Length „return . 61 n~~ tJ the IIpY't'fl. a....... decK Width h Water Height Above Hig Water ' Depth Below L°'~'~ 10' x30' area Excavated Yards to be 80 c!x.:..~'.as Yards to be F filled osited Manner in which material is to be removed or dep Residential Intended use of property ' kiu.g ......an •n fxRx2.t..R~..tkti~..~X15 . To construct•,the„bulkhead,•18!,,,}...•.• Tl e w • ~ -.:.......~~~acett..iax..t~iana,.......~.. ~z...:~~x..~ Conditions if y ~ to ue r lacement of the dock. ~tio;Y, wxucn and to the p . te. ' bulkhead e}:cegt thz„!~Q;...:.....• sJa:.d..da. to speak to the owner of the underwater land Yn r October,•29;,, 1989„if..~:ork,,,h„a~„??9t..&•4F}1117~11Ced.11S•• 2-Trustees•,are, to,•be notified, upon„t1,la..GAITl;2~@:~}4`?.•Q Expiration Date k ................................Y............ Number of Inspections Required the wor 10.00 32265 j ..................laid...~..........)............................... Inspection Fees ' . policies in the Amount of royal of other governmental or municipa Liability such approval. In the ermit is or may be subject to the aPP for or obtaining erations here- of this P accepts no responsibility in applying royal when The validity Town the holder of this permit shall not commence op authorities. The The failure to Trustees upon rePelpt by the 'event that such approval is necessary, under until such approval has been obtained in writing. al authorities of its refusal or required shall subject this permit to immediate revocation by the Trustees of written notice from such other governmental or municiP disapproval. ' I The applicant does by the acceptance of this permit, assume all responsibility for operations under- taken pursuant to this permit, and shall take all precautions for the prevention of injuries to persons and property resulting from such operations. By such acceptance, the applicant also agrees to indemni- fy and save harmless the Town, and its officers, agents and employees from any and all claims arising from operations under this permit and any and all acts or omissions of applicant, his agent and employees. The applicant and the, owner and occupants of the premises upon which the operations authorized by this permit are being ponducted, do, by the acceptance of this permit, give consent to the Town, and IW V~Ilut;ia 4.IU S:I11fl~UYU~..1 W G.I:bI Ii IJUII U14' ail t.llloua VV n~IG JUGII JpGiGUUiIV OIU V...I Iy ....•~JC.. + III make such inspections as the Town may deem necess~r~ to insure that such operations are being rl.>n- ducted inconformity +/vith this pe~mir~ This operation will not substantially: A. Adversely affect the wetlands of the town. B. Cause damage',from erosion, turbidity or siltation. C. Cause saltwater intrusion into the fresh water resources of the town. D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife and vege- tation or the rjatural habitat thereof. - E. Increase the danger of flood and storm-tide damage. F. Adversely off ct navigation on tidal waters or the tidal flow of the tidal waters of the town. G. Change the co~rse of any channel or the natural movement or flow of any waters. H. Weaken or undermine the lateral support of other lands in the vicinity. 1. Otherwise adversely affect the health, safety and general welfare of the people of the to~wn,0. Signed .r,1.2,tFal.../... ~:~-i?:3!-ard.::~(~ Presi nt Board of Southol Town Trustees I Date .......~~..C~~.I.Q. ~.7 I I II I I ICI Ii I 'I I ~I I I I i~-~Q.~ P.~,~.~z. D ~ ~ ~ ~ ~ ~ D BOAaD OF HE.ILTH 3 SETS OF PL.1NS . FORMNO.1 SURVEY ~y~ AUG 1999 TOWN OF SOUTHOLD CHECK 6UILDING DEPARTMENT SEPTIC r• Dart , , , , , , , , , , , , , • BLDG. DEPT. TOWN HALL TOWN OFSOUTHOLD SOUTHOLD, N.Y. 11071 NOTIFY / ' TEL.:765~1802 ~(j- ~ ~ ~ ~vP Eramined.~~Jb..........,19~~ MAIL .p~16-~3.~-7~5~TbS~j G / ~i p.O 13~,~ Z~ ~ Approved ..0~//.~........., 19~/, Permit No..I d..~.~3~ No~s~ ~IL ~V.~/ i 1~5~ Disapproved a//c /e ff::~~.f~~~• (Bull mg I ector) APPLICATION FO BUILDING PERMIT Date u~. 15 V. l INSTRUCTIONS a. Tltis 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 par[ 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 3uilding 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. Tite applicant agrees to comply with all applicable laws, ordinances, building code, ho sink code, and regulations, and to admit authorized inspectors on premises and in building for necessary ' spections Signature of applicant, or name, if a corporation) • (Mailing address of applicant) St(~a'te~1 whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .1,./~/,?N~f ''11 M game of owner of premises rl. i .C~~~r. 1: J..~CJ"Y~.'1 h?~,~, , , , , , , , , , , , , , , (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. N/~... ~*.^?':^:0-.^.~ ' Plumber's License No. n./U ' Electrician's License No. ....~/~..~Q'~".':`:e:`.'..... Other Trade's License No. h /~...°:~:'~~n~ . . Location of land on which proposed ppwo~~rk will be done. p House Number Street. • • • • • • • • • Hamlet rr County Tax ~\1ap No. 1000 Suction ~ ~.7.......... Block • • , ~ . • • , , , Lot • °A,-DQ~. , , . • , • • . Subdivision Filed Atap No. (Nance) Lot............... State existing use and occupancy of {p~remispesand intended use and occupancy of proposed construction: a. Existing use and occupancy ! S:~'•"~""~ b. Intended use and occupancy j .....li-F~Q~~g~ . +v ~ 3. Nature of work heck which Repair ~ _ . • • . • Rc~pplicable): New Uuilding Addition 1? E .~a ,~tcr~ion ,oval Demolition ~ • • • . • . ,y .~i'cr~lVork`::. 4. Estimated Cast . ,1`?~j~6~~, ,I , , , , , , , , • _ . • • . • ' . • • . • • • • . (Description) Fee " ~ (to be paid on filing this application) dwelbn", number of dwelbn a units Number of dwelling units on each (loon , . f e ra c, number of cars 6. Hcb 1'iness:com ~'Stal or mtx cs, if any: Front ..,j,~,r; Z , Dimensrons of x tiny d occupancy, specify nature and extent of cacl} ty ~e of use , . , , , , , , . ~ • • •~tructur " . Nut}tber of Stories , • • • • Rcar ,Jr.~, L' Depth . q7, , , , . . Dimensions of same structure vYith alterations or ad ~ ~•2 ~ " " " " " " " Depth . Fl'.7~ ~litions: Front . Rear `~•}:-21~......... . Flcight 9 . Number of Stones . • • ' 8. Dimensions c~f er]firc new construction: Front ~ j~`~!! ~ ~ ~ ~ ' ' ' Hcigltt . . Numbed of Stones . Rear . , ,~j Depth . Z q.:Zy~...... . 9. Size of lot: Front. ~}ph ~,'3`f,• Rcarr• 10. Date of Purchase ..MPI . ~9~7 , ' . f~~k. ~Qq ~ ...........~epth LtPX..Lc~~7:`~"Q .v.~.~, . p p ~ 1 ameofFormcrOwner r,?m r I ~ 1 1. Zone or use district in which premises are situated . , /,t') ,t, , , , , , , . • . ' ' g' ' ' ' ' ' ' ' • • • • • • • • ! 2. Does ro osed construction viojate any zoning law, ordinance or regulation; 13. Will lot be re;raded ~•f S. . \Vill excess fill be remov •c~.from .premises:. • • • •Yes ~ . • l4. Name of Owner of premises .~4~u ~~Gwi. , , , • .Address 1?0, ~'or 299. n/a.S~~IC,N.Y Nq Name of Architect . ~jFt rrg., , , , , , Phone No.S~6:.73,4.-7?6S. • Name of Contractor . , ,Sg;~, , , • , • . • ' : ' ' • • Address Phonr, No............. . ..Address . • phone No. 15.Is this property localted with in~00 feet of a tidal wetland? *YES,t...,NO.... *If yes, Southold Town Trustees Permit may be required. TY'o5}e<- ~39 _/d~~/~~ PLOT DIAGRAM ~'p~,,,.~:,.; Ck SG6 Locate clearly and distinctly all, buildings, whether existing or proposed, and. indicate aGll+s~b~ck$men ons from property Lines. Give street and block pumber or description according to deed, and show street names and indicate whether interior or comer lot. scrro~~ cR~~K ~0,3~' 2" ti • ~ ti N .6'`~vx ' R 4' Ouk' 1 ~yo ~ oti, u r / ~ ~ _ ~ ~ v r Cc11~.• ~ , 0 _ ~ f"x'~ ~ l ooo.- 7 - S -~G3 . ~n-~r~an ~o~' STATE 0 KE1V YO / =OUNTY F • • • • • • • • , .(Aamc of individual si"nin~•I contract) bovc named. o ' ' ' ' bang duly sworn, deposes and says that he is the applicant Ic is tltc (Contractor, agent, corporate officer, etc.) • ~ • ~ ~ • ~ ~ ~ ' ' ' ' ' ' ' f said owner or owners, and is duly aNthorized to perform or have erformed the said work and to make and file this ~plication; that all stateritcnts contained in this application arc true to the best of his knowledge and belief; and that the ork will be performed in the manner stilt forth in the application filed therewith. vom to before me this • ..............~~~~a/~~...~~..day of 19~~ nary Public, ...,~'C5 . ~ . /?~i~/O~ • County r i/~~~" , NELEN K.OE ROE ` • , PF . NOTARY PUBLIC, State of New York No.1707878,SuttolkCou (Signatureofa licant) Term Ezpfres March 30,19.1 - _ _T,, r. C ~F N~. ~ounclc•-I'1or - / tt~°~ V N S I Iti c ~ r 4-~u~se N93°49'10'"t'? 100,0' p~ i (n1 k f 6 T cn ~ a w Sty , , ~ ~ / ~a. ~ ~ ~ i cr ,~3 ~ d- 3 ~ Ch i 1 / a ~ o I ~ J/ ~ uv Ce~ln~~l ~ cv l.L ~ (J ' CYO 1.5~ M 4 ~ i h ~~-dn~ ~ Qt)~~ ~ ~ ~ ~ ~ ~ \ ~ ~ i ~ X f 5'1' m y ~ i~ n .a' . I h r~ Tv~', j w T ~ Tr v, rCs YV6 p^ S ~f m• 5 " ~ ~ z ~ ~ oW -f +f d 43~f i ~ 4.3'7 s i -N 83 4910` /r i ~ ~?~i ry ~ ~TrU Ve~~a~ ROa~~ ~ ~ t•.•Y'Pr~~ la~'3a~~/ DEC FIB Ala-~7-ISo3 J m Sc c o~ LNrJr~ '~n ( n { Tr~s~~s `•'.1~EC ' I / c_~ 0~ u~'horrn u ~ i ~ ' i PLOT ~~R I~le~/ C~ il~ ~ ORCHf~ k v ~ T. ~Ca~e ~ j0~ 1/ _ L I~~~i~r~rc~~ i~cST rt _ F S~~f~lk Cu~~d~ ~ox PU~~e~" loov-i17.5~4v.3 ~ L ~ i_ Y ~ ~ Lv ST UNDERWRITERSFICAiE ~ ~ P~ ~ ~eli4~ E„1~<.,« ~ ~ ~ ~ a nn~ r ~ AP 0 EDASNOTED3~3 . 11! {}'-J~ /per DATE: ~~6 B.P. M~ NOfIFV BUILDING DEPA N AT SOU N ITI O N 1 L/ 1 N FEE:3d~~~ BY~ _ _ 765-1802 9 AM TD"4 PM OR THE Ca I ~ , ~ ~ O /4 FOLLOWING INSPECTIONS: - - OCCUPANCY OR ' FOR POURED CONCRETE EQUIRED i 2. ROUGH -FRAMING & PLUMBING 1 -}~-i I~ Q L~ ~ J ~ / l~k„j3w L~.T'l;''P~. U5E IS UNIAWFUI- 4. fINA~TiO CONSTRUCTION MUST /.J-"9nsure. 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