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Home My WebLink About18067-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218072 Date JUNE 1, 1989 THIS CERTIFIES that the building ADDITION Location of Property 160 OLD COVE BLVD. SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 052 Block 02 Lot 10.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 18, 1989 pursuant to which Building Permit No. 180672 dated APRIL 24, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to JOHN & ATHENA PHILIPPIDES (owner, } of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING SLIP 5/22/89 PLUMBERS CERTIFICATION DATID N/A L/ uilding Inspector Rev. 1/81 l08ai N0. 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_ Z Dote .......I,JG~Gr!a41:.....t~~..:1 19..~.J. ~ x.8067 Permission is hereby granted to: ~.y...... ~ at premises located at ..~..~.std?......~~....S.N.:~'F...?..lY...!~N.:......~~-fr.4Kkf..l:Q.4~,~ County Tax Map No 1000 Section .....Q S: Block pplot No...~ 0.:...~...... . pursuant to application dated ..~.{~tJ.H.Q.... 19..1., and approved by the Building Inspector. U Fee 3..~~....:.. Building Inspector Rev 6/30/80 TOWN OF SOUTIIOLD BUILDING DEPART?SENT MAY $ F ~q89 TOWN IlALL _ .sJ' BIOG U - 1~ SOUTIIOLD, NEW YORK 1 1 97 1 TOWN OF SG 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY 'l DATE. s~.7~~/ 1........ NEW CONSTRUCTION ._.....OLD OR PRE-E%ISTING BUILDINGI.....V~ACANT LAND...... Location of Property..../.r~.~....... Co Y2 plOQ~__..____Sou,rz-ho%~-•------.. HOUSE NO.--~~ t STREETIl HAMLET Ovner or Owners of Property.. ~LQhh. `g !T.~~~°.»G1-_ ~h' ~~~~_~des County Taa Map No. 1000 Section ..Q~z Block Lot ~ Subdivision Filed Ma/p ........Lot.-././..../... Permit No. ~4 /....Date o£ Permit .yL:Z:y?~..Applicant .JflL'~11 ~~1<l'/.~rHer... Health DepC. Approval Underwriters Approval.__.. Planning Board Approval Request for Temporary Certificate Final Certificate p D z5 Fee Submitted: APPLICANT...:Y..• for T I,~~~,~rer ~ra..e C~ v. tom-' ~ `~D~~ ,y~~p`- C ~ ~`0" rev. 10/14/88 I::LD 1;, S:~C::U; ~~~r,:E ~ ~%t'tME.NT.". ~ r I m i. a ~ i=+ 6 - _ y r0Ut1DAT20:1 (1st) ~ c c OUNDATIOtd ( 2nd } m p, • z o c ROUGH FRAME & PLUMBING c F ti H 3. ~ m n I2dSULATIOCi PER TI. Y. - Y rv STATE EPJERGY CODE _ a 4 . ~ ~ y r FINAL ADDITIOCIAL COMMET7TS: x V ~L - x _ b C H ~ i • ? ~ H H O K O m ~ } c ~ ~ ~-7 a m ^o H ~-G~ ~~w-~.~-e ~-~y ~ ~n-a-U-~, ,~~~'y~ MIQD4E ROAD ~C.tZ. ZT~~4$} ~`i15'111`I~ ~ (>!~orrncrl~ North R.oadl~ 1+ ENE 51bt2C'~ rQ~ HouS~ I ZO' CA ~ C~Nc2G4~ ~Ptl~ Cnt SLcu>,IP LEVEL ka ' ~ Bu,.~tNi:I~~l~Ct:nrel~E~G) t2ss' F£r~ Lo^~5 I ~ ~ ~ to h3Uc~2 t~v-IS'fl~fs C~Nc~2~~ ~~4'ffv $tif: lCr ~ ;o s------•--t k~ fa.c[•sq~fa"s.-It6,b4~ . QLD Pave aou!_t=va~D ~ . E . ~ 1Y ~ I Z ~~wat¢T S+<rVlcc~. 0. t - my 111 O j n D a_ /i ~ 1 I r. 414. t2• ~ ~ t . ? J~ v'G• i 1 r r r t K3 ~ ~.yG~~r~•~`1q~~ I In„nhvha{ nkxatkn °t n1tlgM1/ {Il ~ ~ ~ ~ r 4ctr ns7~ f° o v'Mntton of ~ .R ~~'~ront bwlk:.nv~ N ~ rdu °,~„d the New YMt Sato P ;p ,co~ar. bufk4t(dd to _ 4z'_ N i^"r_: „a,„m-_ xr.r: - Cops of h eurvoy tnq. not beaN , . * ~ (a1{Grm j `tCpS rei~ suneeya s rrvtud Beef a ~ 6 3 a4 F emtwased seal snag: nrrt tro aneldenJ 1 wa Rr mirk ~:+oa vakC kue cnpy - 7,K ` b h ~yerenteex IWrrs<er! hereon enaU run r'br• ti °rly to tho °ervon /w wham the bury LI ~ 4 ~ n0 QvE )s areuared and on his bahai/ to the ~ r`F r'jF~ 1+ j'ut'e comr and govornmeniol nponry and p `1 lord.np invh.uu°n hoed ha con a,W d to tn~ essi ~f Ytc 7>!p AIZ.SHAMOfAA~Ut~ ~ t , Cugnaovol,ham~w'~,.,Irran. floND> r, .,,l:~n,.l~„,r, nre not tm~,o2rahle ,C [ .l C.Ir O( Y.SV ~Sbnl l/ ownNi 1 { f ir,tVt,i:,2~s pIRM2G CHArldED FCC MAP OF PRC3F~12TY ~,rt,~ivt5 :'n s•:ttLt4'~~sUYS 7,~,r~~s& surtvrrYen voa. ...~5..~~''~i"'~ f"`~"~{~...~t^~~~~`,7 N.rl~e: &evcrt~ P.oad and Ot4 _ _ - Cove Boukva,d era krsivai~ roq~. AT >.s~ ' ' AtLSMAMC7MAQUE F,totcr. Lar•r,•~ II ~JOr7:P,'EC!ai'fb ~',Q i+'{'tE' 6'.+5 "srT'12t> , 7 s :1t J ul,~ 9 . i 4TH. Towu osa 5ouT1{oLO, K.Y. 2 v ~.r.- r ~ aUdx'gnteed to The 'title 6µ4vattt4"6 . ~~aF Iv~k,y Co. ds >;urv$yrad Ma~ 6, [9,5$. $Cale : 40 ~ i ~ ~ ~cK va o y ~ H~ y. VAt•t TuYL L~. vpN o° a o ~ ~is~ <s zeetiP~" Lf~cest5ed Land 5urva~or6 ~+.ANOS~ Green~xirt', K, Y. Title Oda. f2S9102 ~ rr nr / a t ~ I _ _ ~ __I j !1 Ht 1 - III - - ~ ~ I i _ ~l - _ - ~ ~ \ \ . 1 _-1 - - o t., O - - - _ - - ` ~ - - - -b - - - _ ~ ~ - Y v...l.__.. - - - - = ~ - a - ~i -i ; -A - - - - - ~ h 1 `I _ _ _ _ _ _ _ _ _ ~d ~4 i j .10 ~ ~ _ - _'a hs n' { I- ti ~ia o - R - _ - -a- - - - ~ o ~ ~ n - -R - - f ~ ~ _A ~ _ 4 ~ - _I_- y ~ ' _ I C ~ _ f i o ti ~ ~oS~FFOtk~o FRANK A KUJAWSKI, 1R ,President ~ ~ T'E[.EPHONE ALBERT J KRUPSKI, JR , Vrce-President ~ . ~ (516) 765.1892 JOHN M BREDEMEYER, III O ~ JOHN L BEDNDSKI, JR 0 HENRY P SMITH 1 ~ BOARD OF TOVi'N TRUSTEE5 TOWN OF SOVTHOLD Town Hall, 53095 Main Road P O Box 728 Southold, New York 11971 October 12, 1988 Mr. John G. Philippides 35 Avalon Road Garden City, New York 11530 Dear Mr. Philippides: The following action was taken by the Board of Town Trustees during their regular meeting held on September 29, 1988 as follows: RESOLVED that the Town Trustees approve the request made by John G. Philippides for a waiver to construct a wooden deck on property located at Old Cove Boulevard, Southold, WHEREAS, an on site inspection was conducted by the Trustees, and WHEREAS, the proposed work is landward of an existing bulkhead on the property. Very truly yours, Frank A. Ku~awski, Jr. President Board of Town Trustees FAK:ip cc: Bldg. Dept. Q~o5~FF0L,~~o Southold Town Board of Appeals ~~ij'`O•~ ~~0~ MAIN ROAD - STATE ROAD 25 SDUTHOL D, L.1., N.Y. 11971 "'~~I11 TELEPHONE (5161 7651809 APPEALS BOARD MEMBERS GERARD P GOEHRINGER, CHAIRMAN CHARLES GRIGONIS, JR SERGE DOYEN, 1R JOSEPH H SAWICKI December 8, 1988 JAMES DIN IZIQ JR Mr. John G. Philippides 35 Avalon Road Garden City, NY 11530 Re: Appeal No. 3772 - Variance for Deck Addition Dear Mr. Philippides: Transmitted herewith for your file and perusal is a copy of the determination rendered by the Board of Appeals recently concerning the above application. Please be sure to return to the Bu>lding Department for issuance of additional documents which may be necessary. A copy of this decision has also been furnished to the Building Department Office to update their files. Yours very truly, GERARD P. GOEHRINGER C RMAN >_n a walsk>_ Enclosure Copy of Decision to: Office of the Building Inspectors Suffolk County Department of Planning Southold Town Board of Appeals O~~~l ~ ~~0~ MAIN ROAD - STATE ROAD 25 SDUTHOLD, L.I., N.Y. 11971 TELEPHONE (5161 7651809 APPEALS e0AR0 MEMBERS GERARD P GOEH RING ER, CHAIRMAN CHARLES GRIGONIS, !R SERGE DOYEN, !R ACTION OF THE BOARD OF APPEALS JOSEPH H SAWICKI JAMES DIN IZIO, JR Appeal No. 3772: Application of JOHN G. PHILIPPIDES for a Variance to the Zoning Ordinance, Article XI, Section 100-119.2 for permission to construct addition at rear of existing dwelling with an insufficient setback from existing bulkhead. Location of Property: South Side of Old Cove Road, Southold, NY; County Tax Map District 1000, Section 52, Block 2, Lot 10.1. WHEREAS, a public hearing was held on October 26, 1988, in the Matter of the Application of JOHN G. PHILIPPIDES under Appeal No. 3772; and WHEREAS, at said hearing all those who desired to be heard and their testimony recorded; 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, its present zoning, and the surrounding areas; and WHEREAS, the Board made the following findings of fact: 1. The premises in question is located along the south side of a private road (known as Old Cove Road) which extends off the west side of Beverly Road, in the Hamlet of Southold, Town of Southold, and is identified on the Suffolk County Tax Maps as District 1000, Section 52, Block 2, Lot 10.1. 2. The subject premises contains a total area of approximately 12,600 sq. ft., lot width of 122.64 feet, lot depth of 102+- feet, and is improved with a single-family, one-story frame dwelling, all as more particularly shown on the Survey dated May 6, 1968, guaranteed July 29, 1970. 6 Page 2 - Appeal No. 3772 Matter of JOHN G. PHILIPPIDES Decision Rendered November 16, 1988 3. By this application, appellant requests a Variance from the Provisions of Article XI, Section 100-119.2B to construct open deck addition at the rear of existing dwelling with a setback at 18 feet from the outer edge of the existing bulkhead along Arshamomaque Pond (or Old Cove}, 4. Article XI, Section 100-119.2B of the Zoning Code (as amended) requires all buildings and structures located on lots upon which a bulkhead, concrete wall, rip-rap or similar structure exists and which is adjacent to tidal water bodies other than the Long Island Sound to be set back not less than seventy-five (75) feet from the bulkhead. 5. The nonconformities of the property and building as exists are noted as follows: (a} the rearyard setback at approximately 25 feet from the ordinary highwater mark, which is seaward of the existing bulkhead; (b) the setback at 19'6" from the outer edge of existing bulkhead. These preexisting nonconformities lend to the practical difficulties and are uniquely related to the premises. 6. It is noted for the record that the property was the subject of a prior variance under appeal application No. 822, decision as rendered January 13, 1966. 7. It is the position of this Board that in considering this application: (a) the relief requested is not substantial in relation to the existing nonconforming setback, being a variance of 1-1/2 feet {19'6" to 18'}; (b) the relief if granted will not alter the essential character of the neighborhood; (c) the difficulties are uniquely related to the property and are not personal in nature; (d} 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; (e) in view of all of the above, the interests ofjustice will best be served by granting the relief requested, as conditionally noted below. Accordingly, on motion by Mr. Sawicki, seconded by Mr. Doyen, it was . ~ , Page 3 - 1~.ppeal No. 3772 Matter of JOHN G. PHILIPPIDES Decision Rendered November 16, 1988 RESOLVED, to GRANT the relief requested under Appeal No. 3772 in the Matter of the Application of JOHN G. PHILIPPIDES for the construction of a 12' by 38' open deck, attached at the rear of existing dwelling structure, SUBJECT TO THE FOLLOWING CONDITIONS: I. That deck not encroach any further than 18 feet from the outer edge of the existing concrete bulkhead; 2. That the deck remain open, unroofed, and not be converted for additional living area {except by formal application; 3. That all lighting, if any, be shielded to the property with mushroom-type cover(s). Vote of the Board: Ayes: Messrs. Goehringer, Doyen, Sawicki and Dinizio. (Absent was: Member Grigonis {out-of-state}. This resolution was duly adopted. GERARD P. GOEHRINGER, CHAIRMAN s New York State Department of Environmental Conservation Building 40-SONY, Stony Brook, New York 11794 / Q DATE: ~~JI0~7 ~ohr1 ~~i~~~p', hr`s ~j ~ 35 ~v ion ~ Re: ~~~~~'~/_g~_',~1 l ~j ~ ~ r Thomas G Jorling ~Y~,}.Q4'~ ~i~J +~J~~ Commtssionor ~ _111 1 Dear ~ ~11~>.QQI ~S~ A revrew has been made of your proposal to: ~~,'~`(~c~" V;~j~ ~(-1~ ~v~,~C ~.`l.,\~~ ~'(~o( PGI~~~O C1S G~~ ~t~ti ~~G'~ p~l ('1 'Ar~~c~~~. ~~e ~ ~~Q ~ Based on the rntonuU~ion you have submitted, the New York State Department of hnvironmental Conservation has determined that the parcel ~J~ project is: Greater than 300' from inventoried tidal wetla ds.~/~;~ I~ Landward of a substantial man-made structure ~l)~~x_1~5.2_ ~111f?~P(~ greater than 100' rn length which was constructed prior to 9 20/77. _ Landward ut the 10' above mean sea level elevatron contour on a gradual, natural slope. Landward of the topographrc crest of a bluff, c1rEf or dune which >.s greater than 10' in elevation above mean sea level. Therefore, no permit is requrred under the Tidal Wetlands Act (Article 25 of the Lnvrronmental Conservation Law). Please be advised, however, that no constructron, sedimentation or disturbance of any kind may take place seaward of the 10' contour or topographic crest without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation rn this area as a result of your project. Such precautions may include provrdrr.g adequate work area between the 10' contour or topographrc crest and the project- (i.e. a 15' to 20' wide construction area) or ereclron of a temporary fence, barrrer, or hay bale be an. Please note that any addrtronaJ work, or modificatrcu to the project as described, may require authorization by this Deparment. Please contact this offLCe rt such are contemplated. Please be further advrsrd that this letter does not relreve you of the respons~brlrty of obtarnrng any necessary permits or approvals from other agencies. Very truly yours, r ~ LeEnrty Iteytunal Permit Adrnrnisttdtot _ _ , ~,~%~~Y , s C~: ~ Southold Town $oard of A eals pp Oyif'0~ MAIN ROAD - STATE ROAD 25 SOUTHOLD, L.I., N.Y. 11971 TELEPHONE (516) 765 1809 APPEALS BOARD MEMBERS G ERARD P GOEHRINGER, CHAIRMAN CHARLES GRIGONIS, JR SERGE DOYEN, JR JOSEPH H SAWIC K! Other Documentation Which is Recommended to Be Submitted in the Initial Step of Application or as soon thereafter as possible, and prior to field inspections by the board members: Most current survey showing all existing structures (as well as proposed). Copies of current deed; Copies of deeds showing 7ega] access to the premises if along a private right-of-way. Accurate surveys certified by a ]icensed engineer or surveyor showing the actual leg a7 right-of-way and the actual traveled width and length (and meandering outside its perimeter tf any). If it is unknown as to whether there have been prior variances or other town approvals, please provide current owner name and precedents of record as close to 1957 as possible. If approvals have recently been received by the Planning Board, Town Trustees, and an other agency, please furnish copies for our file prior to the public hearing date. When notification is sent to adjacentjadjotning property owners, please be sure to notify those surrounding the property (and the right-of-way in question if any). Those names and addresses must be confirmed with the Assessors as shown on the current tax assessment rolls. Any other parcels contiguous to the sub,7ect variance parcel must be shown on the survey since tt may be a part of the same rather than a separate parcel, parttcu1arly subdivisions. Photographs are extremely helpful of bulkhead and landward area. BOARD OF HEALTH 3 SETS OF • PLANS , , • • , FORM N0.1 SURVEY O TOWN OFSOUTHOLD CHECK K BUILDING DEPARTMENT SEPTLC FORh1 1:........ • TOWN HALL 22r~.' EOUTHOLD, N Y. 11971 NOTIFY -~/7 ~ :O~a"Q .~-.r~.+Pi TEL.• 765 180 CALL . Q MAIL T0: APP~ved . ~vw~...?-,7:. I9 89 Permit No 18 0 ~"1 Disapprovedalc (Bwlding Inspector) APPLICATION FOR BUILDING PERMIT ' Date 'Y""". ~~....,IS.~~. 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 plat plan to scale Fee according to schedule. b. Plot plan shoving location of lot and of buildings on premises, relationship to ad}oining premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app capon. 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 Penrtrt to the applicant. Such perm shall be kept on the premises available For inspection throughout the work. e. No building shalt be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bwilding Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demohhon, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, build g code, housing code, end regulations, and t admit authorized inspectots on premises and in building for necessary tnspe ~ton~s. ~QG/f/~ (Signature oi' dpphCant, o~if a corporauon) Via. Sou~ro• •~or1sJ• ~6/Yi~t?l~ • al!,v, • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general eontractor, electrician, plumber or builde, Name ofo:vnerofpremtses „J,oNl~• PNlLIPI?r{XS„•~„WFt;•„•••,,,,,••„•••_•.•••••• (as on the ta;c roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. . ~39y3 ~ Z.• • • • • • Plumber's License No . Electrician's License No . Ot}ierTradc's License No . 16Q I. Location of land on which ptoposcd work will be done. 6,oY~ $outfYARp SrItD ®.CA•,Cd?d• $uu46Yh29 S,ou7/sisLD house Number Street Hamlet County Ta? ivfap No. 1000 Section . s'2 Block .....2,i Lat • ..l4.'f'.......... . Subdivision Filed 1<lap No. Lot . (Name) State c~istmg use and occupancy of premises and intended use and occupancy of proposed construction: i a. Eeisting use and occupancy sing~~ • ~ar»!~y, • ,,{res.!las~ae. b. Intended use and occupancy • 3. Nature of work (check which applicable) New pudding Additron .~~.~Lk • . • rUterauon . Repair Removal Demotrtron Other 1Vork . It x 30 JJ6c~ st /o/rd st~.ts mean ~ (Dcscnpuon r.- 4. Estimated Cost G ~ Fee . . (to be pard on filing ilia apphcatwn) 5. If dwelling, number of dwelling units Number of dwcllrng units on each floor . Ifgaragc,numbcrofcars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Drmensrons of cersting structures, it any• Fron . Rcar Depth . Hcr_^_}tt Num er f . . Drmensrons of same stntcture cr ns or additions Front Rear . Depth Icrght . Number of Stones Drmensrons of entire new consttuction: Front . . . Rear Depth Hei;lit ...............NumberofStones................................... 9. Size of lot. Front Rcar....................,, Depth 10. Date of Purchase .............................Name of Former Owner 1 1. Zone or use district in which premises are situated . !~~s!'.'~.h ~?!!-l . 12. Does proposed construction vioiate any zoning law, ordinance or regulation: Y~S~ see, rq4, , , , , , , 13. Ndl lot be regraded 1Vi11 excess fill be removed from premises: Yes 14. Name of Owner of premises !T~:'^:'.':S:/~?°./!ifs.... Address3,5.:lrsurd?, B*;PLL!.vuA^ phone No......... Name of Architect .Address . .................Phone No............ . Name of Contractor .TI~~2'. f.!S~'s'614........... Address.2a S.°NA:4?.D, G~°j:... Phone No. `.?.7.7:".~ ~ 15.Is this property located within~00 feet of a tidal wetland? *YES.tl.NO.... *If yes, Southold Town Trustees PermiC may be required. J,=e 47,~,~RGges~ PLOT DIAGRAM ~~rmi~f Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dunensions fr property lines Give street and block number or descnption according to deed, and show street names and indicate whet intenor or comer lot. / ~ J~ ~G[r ~f4 SGG 0.ILl~-'t G'l.C.~~~"H/~S ~I"~rr %rus.4c <s / D E. c. w,rr a' r.r , +t ~c cis /.cyu.cf APPROVED AS NDTEDo~~ ~ ~ ~sc,r aGe~va-a srnt,-! DATE 8 g B P t1~~-J~f~-•,-~--- FE E S"a ~ BY ,_r tom..---^' NOTIFV SUrLDING DEPPRMTr MOR THE 7n5-t$62 9 AM TO 4 FOttO4NING iNSPECTITO`NNO REOUIRED ~ FOUNDATION FOR POURED CONCRETE 2 ROUGH - Fl?AMtNG & PLUMBING OCCURANCY OR 3 INSULATION 4 FINAL - CONSTRUCTION MUST USE (S UNLAWFN( BE coME'IETE FOR c.o. 4Yt1'Ftp~r C~RrtFICATt: ALL CONSTRUCTION SHAD- MEET' of OCCUPANCY THE REQUIREMENT5 OF THE N.Y STATE CONSTRRES'PON3181-EEFOR CODES NOT DESIGN OR CONSTRUCTION ERRORS STATE OF'~E1V YORK, S.S COUNTY OF . /7.r n! ~ f , , L .Cis e , . _ , , , , , . , , being duly sworn, deposes and says that he is the applic (A'amc of mdrvrdual si;nuio contract) above named. fie is the ~'..°ntr~ G~»r (Contractor, agent, corporate officer, etc.) ~f said owner or owncn, and is duly authonzcd [o perform or have performed the Bard work and to make and Gle ~pphcauon; that all statements contained m tars application are true to the best of his knowledge and belief; and that •vork wdl be performed rn the manner set forth m the application filed therewith. HEIENKOEVOE sworn to before me this NDTARYPt19tIC,Stateatt No 4707878,SuHoIkC~ ~ Terns Expires Alrsrch 30.1 .otary Public, ! . •4~• . - • County ,i • +wt (Signature~ofapplic