HomeMy WebLinkAbout17733-z'~ FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18132 Date JUNE 21, 1989
THIS CERTIFIES that the building ACCESSORY
Location of Property 3331 ROW OFF GRAND AVE. MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 107 Block Ol Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 15, 1988 pursuant to which
Building Permit No. 17733-Z dated JANUARY 4, 1989
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy far which this certificate is
issued is ACCESSORY BUILDING AS APPROVEB BY ZBA #3804
The certificate is issued to ELLEN BLACK GUYTON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
B ding Inspector
Rev. 1/81
Foeai xa s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N ~ X11 ~ _~ .~ ~ Z Date ....~~~:......1 ............... 19.Q.
Permission is hereby granted to:
to ..?.,/...~..l.7Fl.:^:::4.5.!!.'...., d~.a....G~.:4:,G'.+4~4.-:4-~'ac'.~... ......... ... .....~....Gt~~t¢~.R•r.~:•~":`•,
ct premises located of ...~.ski.~.~......~ :...............~4{.....i7.•....!-1.K.`.r.,..........~.KxArLK.(:f~-...
Caunty Tax Map No. 1000 Section .....1.Q••~•••••••. Block ....~..~........... t~Lot No...... ~.~ ...............
pursuant to application doted ..~~:?'•'^:1!~:~-~:..••••~••~~.r~••••••••••••, 19...4.., and approved by the
Building Inspector.
Fee $..I..~~.:..~.v
..~. ti v!....~,
Rev. 6/30/80
TOWN OF SOUTDOLD
BUILDING DEPART.`IENT
TOWN IlALL
SOUTIIOLD, NEW YORK 11971
765 - 1802
~.o. Q~ks~y
~n~- ~°~i ~ «S~
APPLICATION FOR CERTIFICATE OP OCCIIPANCY
DATE.. C~.L?:~:? .......
NEW CONSTRUCTION ..",,,_,OLD OR PRE-E%ISTING BUILDING......VACANT LAND.._.._..
Location of Property..~3.~J,i.... JZC'ieJJ... C7~~ ~-'(Z-~~_ ~~ ~~~~,f,
NOUSE NO. STREET ~ ~ ~ ~'~! _ _ _l~te.
~~~---...~~~ '~,`~ IlAMLET
Owner or Owners of Property..~~'~'~~__~L.,.CT~~
I_...........
County Taa Map No. ]000 Sectio^ fV ~_. Block ~ ~ ~I
....... Lot .........
„ Subdivision ....................... Filed Map ........Lot..........
Permit ao. ..........Date of PermiC ..........Applicant ...................
Ucaleh Depe. Approval .................. Underwriters Approval..........__..
Planning Board Approval ................
Request Eor Temporary Certificate ......
. Final Certificate ......
Fec Submitted:
APPLICANT~~~~~\~~~~I~FLUI~T CC)JC~
Z/Ti.~
r~~• 10/14/88
a~• 356,5
Cod 1132
i '
FORM N0. 6
i TOWN OF SOUTNOLD ~ ~ "
~I BUILDING DEPARTMENT
'~ TOWN HALL
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must b~ filed in typewriter OR ink and submitted to the Building
Inspector with the follgwing; for new buildings 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 of Health Dept. of eater supply and sewerage-disposal(S-9 form),
3. Approval of electrical installation from Board of Fire Underwriters,
4. Sworn statement from ,plumber certifying that solder used in system contains less
than 2/10 of IZ lead .j
5, Commercial buildings,' industrial buildings, multiple residences and similar,
buildings and installations, a certificate of code compliance from the Architect'
or Engineer responsib'1e for the building,
6. SubmiC Planning Board Approval of completed site plan requirements.
B. For existing buildings (~rior to April 9, 1957] non-conforming uses, or buildings
and "pre-existing land uses:
I. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or topographic features.
2. A properly completed application, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire lot prior to April 9, 1957.
Zf a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in ciFiting to the applicant.
3. Date of any housing epde or safety inspection of buildings or premises, or other
pertinent information; required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
1. An application for vaunt land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of'~the entire lot prior to April 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor is writing to the applicant.
D. FEES:
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions Co Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Fool, $25.00, Accessory building $25.00
Addition to Acces~+ory buildings, $25.00 - Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00,
3. Copy of Certifica~+e of Occupancy - $5.00 - over 5 years - $10.00
4. Vacant Land Certificate of Occupancy - $20.00
S. Updated Certifica[~e of Occupancy - $50.00
6. Temporary Certificate of Occupancy -'$25.00 Residential
~ $50.00 Commercial
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APPEALS BOARD
MEMBERS
Southold Town Board of Appeals
MAIN ROAD - STATE ROAD 25 SOUTHOLD, L.I., N.Y. 11971
TELEPHONE (516) 765-1809
GERARD P. GOEHRINGER, CHAIRMAN
CHARLES GRIGONIS, JR.
SERGE DOYEN, JR.
JOSEPH H. SAWICKI
JAMES DINIZIO, JR.
ACTION OF THE BOARD OF APPEALS
Appeal No. 3804:
Upon application of ~~- ,,, ~'~;for a Variance to
the Zoning Ordinance, Article III, Sectian 100-32 and Article
XI, Section 100-118 for permission to rebuild nonconforming
accessory (storage-garage} building in the frontyard area.
Location of Property: 3331 Private Right-of-Way extending off
the west (northwest) side of Grand Avenue, Mattituck, NY;
County Tax Map District 1000, Section 107, Block O1, Lot 11.
WHEREAS, a public hearing was held and concluded on
December 8, 1988 in the Matter of the Application of ELLEN BLACK
GUYTON under Appeal No. 3804; and
WHEREAS, at said hearing all those who desired to be heard
were 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:
Page 2 -•Appl. No. 3804
Matter of ELLEN BLACK GUYTON
Decision Rendered December 16, 1988
1. By this application, appellant requests a Variance
under Article III, Section 100-32, and Article XI, Section
100-118 for permission to rebuild accessory building0 of a size
35 ft. x 21 ft., replacing an existing accessory storage
building, in the frontyard area, as more particularly shown by
Map prepared by Roderick VanTuyl, P.C. December 6, 1988 (for
Mary A. Black dated October 7, 1968).
2. The premises in question is a described parcel of land
containing a total lot area of ,approximately 1.75 acres with
198.18 ft. frontage along the westerly side of a private
right-of-way (which extends off the west side of Grand Avenue)
and 205.21 feet (tie line) along Mattituck Creek, Hamlet of
Mattituck, Town of Southold, more particularly identified on the
Suffolk County Tax Maps as District 1000, Section 107, Block 1,
Lot 11.
3. The subject parcel is improved with a single-family,
two-story frame house and three accessory structures, all as
shown on the above-mentioned survey.
4. The accessory building which is the subject of this
application is proposed to be located four feet from its nearest
setback to the front property line in the general "footprint" of
the structure being replaced. The structure is shown to be set
back 110+- feet from the ordinary highwater mark of Mattituck
Creek (to the west) and 40+- feet from the northerly (side)
property line.
5. Article III, Section 100-32 of the Zoning Code provides
accessory buildings to be located only in the required rear
yard.
6. Article XI, Section 100-118 of the Zoning Code
prohibits replacement of nonconforming buildings by more than
50% of its fair market value.
7. It is the position of this Board in considering this
application that:
(a) the circumstances are unique to the property and
are not personal in nature;
(b) the relief requested is not unreasonable and is
the minimal necessary;
(c) the relief requested will not alter the essential
character of the neighborhood;
(d) there are other accessory buildings also located
in the frontyard area;
(e) there is no other method feasible for appellant
to pursue other than a variance;
Page 3 - Appeal No. 3804
Matter of ELLEN BLACK GUYTON
Decision Rendered December 16, 1988
(f) the variance, if granted, will not in turn be adverse
to the safety, health, welfare, comfort, convenience, or order
of the town, or be adverse to neighboring properties;
(g) the interests of justice will be served by granting
the variance.
Accordingly, on motion by Mr. Dinizio, seconded by
Mr. Goehringer, it was
RESOLVED, to GRANT the relief requested under Appeal
No. 3804 in the Matter of ELLEN B. GUYTON for permission to
replace accessory building in the frontyard area, to be used
accessory and incidental to the residential use of the premises
(for storage purposes), SUBJECT TO THE FOLLOWING CONDITIONS:
1. No plumbing or other utilities permitted, with the
exception of electricity;
2. The frontyard setback be no closer than that as applied;
3. No excavation or disturbance to areas seaward of the
subject building(s};
4. The subject accessory building not be used for sleeping
or habitable quarters.
Vote of the Board: Ayes: Messrs. Goehringer, Grigonis`,
Sawicki and Dinizio. (Member Doyen was absent due to serious
family illness.) This resolution was duly adopted.
GERARD P. GOEHRINGER, HAC IRMAN
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
Date ..<~.$".'`'.°ryw~.....~ ~?...., 19 ~~.
~~.
.:~3~ ?~..~ 9.~ ....................... .
PLEASE TAKE NOTICE that your application dated .. !!! , , < <P, , , , , , „ 19 .
for permit to 4 ~- ~t . CLc.~ , , ~;? ~ ~ , ., , A) ;9;~;J dv~v..
tt ...............at
33 1 ~. c3.~-J .
Location of Property .......... ~~ , .~ ~:. , , . 44ue . , , ~,of,Q C;t¢ .............. .
House No. Sheet Hamlet
County Tax Map No. 1000 Section ../..Q,~, , . , ...Block ...®. ~......... Lot .. I ~......... .
Subdivision ................. Filed Map No. ........ , ....... Lot No. .......'......... .
is returned herewith and disapproved on the following grounds . (~ 44*.+, ~.dYI :'.,~-,Z; , , , , , , . , ,
U ~.. ~y. b
~ ~ '~~~
................................................................................
...................................................................
...................................................................
...................................................................
...................................................................
........................................ ........... ..............
Building Inspector
RV 1/80
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SUFFOC,~~
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~ ~ Southold Town Board of Appeals
o; ~
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~~0~ MAIN ROAD - STATE ROAD 25 SOLJTHOLD, L.I., N.Y. 11971
q
"YS° TELEPHONE (516) 765-1509
APPEALS BOARD
MEMBERS
GERARD P. GOEH RINGER, CHAIRMAN
CHARLES GRIGONIS, JR.
SERGE DDYEN, 1R.
JOSEPH H. SAWICKI December 27, 1988
JAMES DINIZIO, JR.
Mr. Derrick Doubrava, President
Peconic Development Corp.
P.O. Box 594
Mattituck, NY 11952
Re: Appl. No. 3804 - Ellen Black Guyton
Dear Mr. Doubrava:
Transmitted herewith for your file and perusal is a copy of
the determination rendered by the Board of Appeals at our
December 16, 1988 Special Meeting.
Please be sure to return to the Building Department and any
other agency which may have jurisdiction 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
CHAIRMAN
By Linda Kowalski
Enclosure
Copy of Decision to:
Office of the Building Inspectors
Suffolk County Department of Planning
• ~~g~FFOC/>'COG
o;=~~'.~a, ,~ ~ bout®ld Town hoard of Appeals
~0~ ~ y~`,~ MAIN ROAD STATE ROAD 25 SDUTHOLD, L.I., N.Y. 11971
TELEPHONE 1516) 765-7809
APPEALS BOARD
MEMBERS
GERARD P. GOEHRINGER, CHAIRMAN
CHARLES GRIGONIS, JR.
SERGE DOYEN, JR.
JOSEPH H. SAWIC KI
JAMES DIN1210, JR.
Appeal No. 3804:
y
ACTION OF THE BOARD OF APPEALS
Upon application of ELLEN BLACK GUYTON for a Variance to
the Zoning Ordinance, Article III, Section 100-32 and Article
XI, Section 100-118 for permission to rebuild nonconforming
accessory (storage-garage) building in the frontyard area.
Location of Property: 3331 Private Right-of-Way extending off
the west (northwest) side of Grand Avenue, Mattituck, NY;
County Tax Map District 1000, Section 107, Block O1, Lot 11.
WHEREAS, a public hearing was held and concluded on _
December 8, 1988 in the Matter of the Application of ELLEN BLACK
GUYTON under Appeal No. 3804; and
WHEREAS, at said hearing all those who desired to be heard
were 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:
Page 2 - Appl. No. 3804
Matter of ELLEN BLACK GUYTON
Decision Rendered December 16, 1988
1. By this application, appellant requests a Variance
under Article III, Section 100-32, and Article XI, Section
100-118 for permission to rebuild accessory building0 of a size
35 ft. x 21 ft., replacing an existing accessory storage
building, in the frontyard area, as more particularly shown by
Map prepared by Roderick VanTuyl, P.C. December 6, 1988 (for
Mary A. Black dated October 7, 1968).
2. The premises in question is a described parcel of land
containing a total lot area of ,approximately 1.75 acres with
198.18 ft. frontage along the westerly side of a private
right'of-way (which extends off the west side of Grand Avenue)
and 205.21 feet (tie line) along Mattituck Creek, Hamlet of
Mattituck, Town of Southold, more particularly identified on the
Suffolk County Tax Maps as District 1000, Section 107, Block 1,
Lot 11.
3. The subject parcel is improved with a single-family,
two-story frame house and three accessory structures, all as
shown on the above-mentioned survey.
4. The accessory building which is the subject of this
application is proposed to be located four feet from its nearest
setback to the front property line in the general "footprint" of
the structure being replaced. The structure is shown to be set
back 110+- feet from the ordinary highwater mark of Mattituck
Creek (to the west) and 40+- feet from the northerly (side)
property line.
5. Article III, Section 100-32 of the Zoning Code provides
accessory buildings to be located only in the required rear
yard.
6. Article XI, Section 100-118 of the Zoning Code
prohibits replacement of nonconforming buildings by more than
SOo of its fair market value.
7. It is the position of this Board in considering this
application that:
(a) the circumstances are unique to the property and
are not personal in nature;
(b) the relief requested is not unreasonable and is
the minimal necessary;
(c) the relief requested will not alter the essential
character of the neighborhood;
(d) there are other accessory buildings also located
in the frontyard area;
(e) there is no other method feasible for appellant
to pursue other than a variance;
• Page 3 - Appeal No. 3804
Matter of ELLEN BLACK GUYTON
Decision Rendered December 16, 1988
(f) the variance, if granted, will not in turn be adverse
to the safety, health, welfare, comfort, convenience, or order
of the town, or be adverse to neighboring properties;
(g) the interests of justice will be served by granting
the variance.
Accordingly, on motion by Mr. Dinizio, seconded by
Mr. Goehringer, it was
RESOLVED, to GRANT the relief requested under Appeal
No. 3804 in the Matter of ELLEN B. GUYTON for permission to
replace accessory building in the frontyard area, to be used
accessory and incidental to the residential use of the premises
(for storage purposes), SUBJECT TO THE FOLLOWING CONDITIONS:
1. No plumbing or other utilities permitted, with the
exception of electricity;
2. The frontyard setback be no closer than that as applied;
3. No excavation or disturbance to areas seaward of the
subject building(s);
4. The subject accessory building not be used for sleeping
or habitable quarters.
Vote of the Board: Ayes: Messrs. Goehringer, Grigonis,
Sawicki and Dinizio. (Member Doyen was absent due to serious
family illness.) This resolution was duly adopted.
lk ~ '
~,. I/~~.
GERARD P. GOEHRINGER, CHAIRMAN
765-1802
BUILDING DEPT.
ii:Fi~~TiiL~7`l
[ J FOUNDATION i5T [ ] ROUGH PLBG.
[ J FOUNDATMON 2ND [)INSULATION
[ ]FRAMING r~J FINAL
REMARKS: ~. (~'.. ~
DATE 7 -~ INSPECTOR ~ - ~,
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BOARD OF HEALTH ............
3 SETS OF PLANS ............
FORM N0. 1 SURVEY
.....................
TOWN OFSOUTHOLD CHECK ......................
BUILDING DEPARTMENT SEPTIC FORM ................
' TOWN HALL
SOUTHOLD,N.Y.11971 NOTIFY ~a~• ~~~
TEL.: 765-1802 CALL
Examined . ..... 7..., 19~~ MAIL T0:
Approved V `.'~...., 19~. Permit No. 1.~.?~3.~,.
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date .. ~~~'. ~.i`~......., 19
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 inspections.
..1~. C~n1t G.`.-~.~r..~.P4~-.. jam. (~'/f~NTI". Cc~c~. - .. .
(Signature of applicant, or name, if a corporatton)
• (Mailing address of applicant) I ~ ~~
State whether applicant is owner, lessee, agent, architect, engineer eral contractor electrician, plumber or builder.
................................................................................................
Name of owner of premises .. ~.r (,.(!~ l.l..l .../r~!7Sd~-' .......~ ..................................... .
(as o~ tax roll or latest deed)
If icant • or ratio~,Isi_gn'ature of duly authorized officer.
.~. .....~r4~!'.~'~:~'~......G~r.'. .......
(Name and title of corporate officer)
Builder's License No. .. ~-.~.~.~... f"7.~........
Plutnber's License No . ....................... .
Electrician's License No . ..................... .
Other Trade's License No . ..................... ~~~1 ~/~,,~
1. Location of land on which proposed work will be done. . ~..~ \ ~~~ ~,~, , , ,7UV~y ,
House Number Street / Hamlet
County Tax Map No. ]000 Section .I~~............ Block .... ! ............. Lot ... ~~
Subdivision ..................................... Filed Alap No. .............. Lot .............. .
(Name)
2. State existing use and occupancy of premises and intendedc~use and occupancy of proposed construction:
a. Existing use and occupancy ......C~.'... •.• ~d••••~.7~„•••••••••,•„•••••••••••••••••
b. Intended use and occupancy ~ • • • • • ~/• • • • • • • ...... •
........... ...............................
I
3 Repair of work (check whicH applicable ew Buil .....•... , . Addition .......... Alteration ........ .
• • • • .. amoval ..... . ....... . Demolition ..............Other Work ............. .
4. Estimated Cost ..... ~ , ~ ~-' (Description)
.. Qom! ....................... Fee .....................................
(to be paid on filing this application)
5. If dwelling, number of dwelli' , , , , , , , g
If ara~e, number of cars J}tg units . Nl~`". Number of dwellin units on each floor ..lu~?Q-'
g o ~.... ..T ......... ................. ....... ..
....... ...........................
ti. If business, commercial or mined occupancy, specify nature and extent of each type of use ...../~,~; , , , , , , , , , ,
Hei~}tt g Nures, if any: Front ............... Rear .............. Depth ............. .
ry Dimensions of lamer tructureµmber of Stories .......................................... .',
o ...........
!with alterations or additions: Front ................. Rear ................ .
epth .................. .
8. Dimgensions of entire new cony ' • Ileight ..... , • +, , , , , , , Number of Stories ............. ~...... .
struction: Front ..3r? r//~~ ... , , , . Rear ..... t.~. ~ .......Depth Z;/
Hei ht ~.~ .~..... Number of Stories .... ~ !?, , , ~ ~ ~ ' • ' ~ •
......... ....
9. Size of lot: Front .....~Qb, ~.. Rear . ,~p~S , , , , , , , , , , Depth .,1219'.-, ,fie 3''~~ • ~ ~ ~ •
10, Date of Purchase ..... 4
•~!~'• • G. • • .......Name of Former Owner ............... .
1 1. Zone or use district in which premises af'e situated ,, , , , , , , , , , , , • • ~ • ~ ~ ~ •
...
12. Does proposed construction violate any zoning law, ordinance or regulation: .~ ... ~~ .................. .
13, Will lot be regradedp ...... N~? .................. Will excess fill be removed o>~premises: N Yes No
14, Name of Owner of remises~LC, fiA.1. l~i.~4(~C,,Cru:~4bilpddress t'..a; 3c+DC,~PT~ X01 N~ ,phone No. S~~/. ; ',~yrj,21~ ,
Name of Architect ........' . ,Address ~~'~"T,m~!~1b' J~/`r'y`f ,phone No. .
Name of Contractor ~C4t'`l!41.2?£t/G.64t'. (t'tE~ di4~1Pi Address l~..+, ~ vJy , j'!'!4,'~1 ,Phone No.? ~ ,-~`j `/L,,$';', ,
I5.Is this property located within 300 feet of a tidal wetland? *YES....NO....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly 5111 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.
STATE OF NEW YORK, I S S
COUNTY OF ................ .
"' ' ' ' ' ' ' ' ' ' ' • • • • • • • • • • • • • • • . • .... being duly sworn, deposes and says that he is the applicant
(Name of individual sig'ping contract)
above named.
He is the .....................! ................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements coni(ained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manngr set forth in the application filed therewith.
Sworn to before me this
Notary Public, .....(' ,7,~ ';, , !v;~ ~!?•e; , , , , , County
HELEN K. DE VOE ................. ......... .
NOTARY PUBLIC, State at NewYarlj a~-- J~ ` _ (~ _ ~ (Signature of applicant)
No. 47WSTA, SuHofk Coun /~~~yut.
Term Expires March 30,19
N~OI l EL/ZABETH
' )/ FOX
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PROPER T Y
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TOWN OF 'SOUTHOLD
SUFFOLK COUNTY, N Y.
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March 17, 1989
N/O/F
HARRIET K. GOTTA