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HomeMy WebLinkAbout18328-z ' _ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18977 Date APRIL 18, 1990 THIS CERTIFIES that the building ALTERATION Location of Property 5285 PECONIC BAY BLVD. LAUREL N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 128 Block 1 Lot 19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 12, 1989 pursuant to which Building Permit No. 18328-Z dated JULY 26, 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 ALTERATION TO EXISTING ATTACHED GARAGE AS APPLIED FOR. The certificate is issued to MICHAEL & JANE FITZPATRICK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/~A UNDERWRITERS CERTIFICATE NO. H-014843-MARCH 22, 1990 PLUMBERS CERTIFICATION DATED APRIL 12, 1990-MICHAEL FITZPATRICK Building Inspector Rev. 1/81 rosat< xo. s TOWN OP SOUTHOLD BUILDING DEPARTMEN4 TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N Q 8 J G~ Z Date ...~7-{. r 19.G[.1~. Permission is hereby granted o' ~ ~ .....ll!.......~'....... ~r...i.....~e.....~~.°...D ...........L/.`~.lR~........ ....~.r~...... at premises located at ......~~..~i~r1... /~J~..'.'.1.,._.~/..~J~...~fk.CC/......!4i.~....Q~..........1 .....................................................C~,.L~~~~-f ...............................................................................GG................................................................................ County Tox Map No. 1000 Section ........~.~0.... Block .............~.....yLot Na........~....... pursuant to application dated ...............7/ 19..,Y.. and approved by the Building Inspector. Fee S•.la••~.!•s1! B (ding I r Rev. 6/30/80 Form No. 6 • ~ TOWN OF SOUTHOLD --~='.I~?'~~~~~" BUILDING DEPARTMENT TOWN HALL "i i~~ ~ APR ~ t'r 76s-lsoz 16 ~ 1"C)tNt•,~ OF 5JL17FaOL~±°3 ~ APPLICATION FOR CERTIFICATE OF OCCUPANOY ~~~z...»_,,,~,,,'-a.,,,_,,, 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-4 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. 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 Berard 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. v• Fees 1. Certificate of Occupancy dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling 25.00 Swimming pool $25.00, Accessory building $25.00, Additions to accessory bui ang $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 $'15.00, Commercial $15.00 Gan,r~~e., Date .~.1?!zlS....~.?:).. COI.O1/e{btlQ`~ New Construction........... Old Or Pre-existing Building Lccaticn o£ Property:S28S, AECON/ G ..dqY B;Vn ...4q~REG- . . House No. Street Hamlet Onwer or Owners of Property~/!~rC"~AEL, d..T/awE... F/T2+°Ar~'/CK County Tax Map No 1000, Section..a ......Block...... ~ ........Lot.... ~.g Subdivision ....................................Filed Map............Lot...................... Permit No... ~8:3.L g..2.°Date Of Permit. .8.9...Applicant //?!Cy!!EL ..,FiTZPgT.PiC.~ Health Dept. Approval ..........................Underwriters Approval GT236G90~90,..//7,q~22~/99U Planning Board Approval Request for: Temporary Certificate........... Final Certicate. F!:v'Q L . Fee Submitted: $,~„Ze~ ~G ~j~~ ~ ,o p~ CO ~ ~ ~ APPLICANT ~0~~~~a~~CD/, TEL. 7G5-1802 TORN OF SO~JTBO,L3~ 1.,:;^ ~ . < OFFICE OF BUILDIPIG INSPECTOR o P.O. BOX 728 ~ t 0/j. ~ ~ SOUTHULD, N Y 11971 ~~3 ~~l ~ ~ APR ~ 6 i~~JO ~r~ i ' e. ~J,i~ ~~a~.. _ _ ~~-N~ i r~l.isa. ; TC14"J[Q i;F S(J C E R T I F I C A T I O N ~,zw...w.~~.,..,., Date f~~R~ ~ 7a~ /99~ Huildirq Permit No. ~~3a~z owner f19/CH11~G T. y .9~v-~ F / TZ /~~~~/C (please print) Plu^.ber/Y//G~1AFL Fi7'LPA??/C,~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1g lead. e (plumber's 'yn~ ure) Sworn to before me this / _~day of ~ P 19~, ' j~j r~ Publ.ic~ t7otary Public, f ~ v'im' u~~ou~s ,LAMES J. HAMICfON, JET?. i~0tary public, Stafe of New York No. 03-F748500 QualiPiptl in Wcsfchester County Commission Expires September 30, 79811 THE NEW YORK BOARD OF FtRf UNDERWRITERS PAhr: 1 _ R0177Ji8 BUREAU OF ELECTRICITY 33 JOHN STREET. NEW YORK, NEW YORK 70088 - Dak NARf[{ 21,1.990 Application No. onJ3ile 6'7'h:1tiF90f!)0 N 0.14£143 - THIS CERTIFIES THAT P}.RNtC N11. 113.11.8'!. - onlythe tlactricd epuipment w dsurilAed 6elorD and ineroduced 6y ehe applicant nerved on the ahooe opp/ieation nuasMr iw the promlwe of N1t;RAEL P'T.TZPATRiCK, 5285 PIti4ONIC BAY' BI,YD., 1,Al1RRIA, N.Y. f R ® IAt Fl. ®Ynd Fl. GAR Sertionl l$ Blockl I.ot :19 in the ollo,rin hTCOCIOn; ? 8wement NARt;R '1.2,1.990 +r eras esomined art and found tG 6e in cornpliancr with the reyuirernentAOf ehL Bard. - RXTUR! RXTURK RANOES COOKING oRClcf OVENS OBIT W EXHAUST PANS _ OUTLLTf AQIS SWIT016 INCANDESCENT FlUDI1ESCENi OTNEFI AMT. t. W. AMT. W. NAT. K.W. AMT. K. W. AMT. N. P. z3 b2 1'r r' - DRYERS FURNACE MOTORS H/IURE Af/l1ANCR PNDRRf fPROAl RRC1T 11RIE ClOCKf RHL aNIT IIfAIERt IAIIU{.OY[IET DYAAYRS AMT. K. W. ql H. P. GAS N. t. AMT. NO. A. W. G. AMT. AMl. AML M1P6. TRANS. ,AMT. N. P. ~ AMT. WATES _ 1 2 b00 SRVK7 BBCOIINiCT ND.OI S E R V 1 C i AMT, AAM. T'!Pe 1 / tW t A aw t A eW 3,r AW KR 4COND, a CC cd10. No. a Ni.uo a~M.~ ND. a N[NiAlt a a. l OTIRtR APMMTUS: W1RI:NG F'OR DY.TACB~KI) GAR.IST&2N1) FL,. -1 - Y.1,IiC. ROOK BffATP7R5:3-2 K..W.,3--,5 F..N.,X...1.9 K.1i. N:L1iC. WATBR H1sATE:RS::i.°3,Ii H'.W. G."r".C.1:-7 - . NICRA61, E'IT'l.PATRICK 283 AViti."('" APT 9D _ NF.W YORK. C LY'Y, NY, 10009 OE?ERTAI MANAO/t 11 Psr ~..-r This cartifiwh mwt not be alNrad in a,ry mamlar; return to the office of 11a Board if incorraci. lnsp~ctors may be idantifid by 1Mir cradaMiak. COPY FOR BIRLDING DEPARTMBIT. THIS COPY OF CERTIFIGTE MUST ~T BE XLT®t~ #l..MAIMIER, t yes.-..,~__:. T~ _ _ T .T _ T_. ~ THE NEW YORK BOARD ~F FIRE UNDERWRITERS PA`r. j 7.001.450 oUREAU OF ELECTRICITY 88 JOHN STREET, NEW YORK, NEW YORK 0038 I ,Inr~lrn~v {~a:1934 516o8ua~}s, ~ flss7o~ Oste - Application No. on file THIS CERTIFIES THAT only tlu ekectded putpment o. deecrifAed 6eloto and introduced 6y the applicont noFnsd on the ahooe app8cation numfter in the pranFisss of M.J. FT'I'7,P~TR1:('x, HI!tCH I)R k PF;COHCC i3A`[ RT,VU, LAtfkf;(,, N.Y. in the dbafn lace f:Ax /(TII'P f R NL~;r~1~BOJ'~'"'P'9'x8 ? IKt FI. ? YF.d FI. Section Bork Lot FOae examined on oMl found to fx to romplionee with the reyutrementK of this Bwrd. MXTYRE AQif fW1TCNES IfTURES RANOB COOIIIN6 DECIIf OVENS DISH WASHERS EXHAUST FANS OUTLETS INUNOFSCFNT FIUdESCMT AMT. K. W. AMi. K. W. AMT. K.W. AMT. K. W. NAT. N. P. i , DRYERS RIRNAOT MOTORS M/1UR! AMIIANCE RBMRf fMXYAF.RSt'?T TIf1E f10ClIf N9l UMT HEATERS IAULIMDUitET OMAMlRS AMT. K. W. pl N. P. GAS N. P. AMT. NO. A. W. 6. AMT. AAV. AMT. AAVS. .TRANS. AMT. N. P. a ~T AMT. WATTS fNVIW OIfCOPMNCT MOOS S E R Y ; C E ar AMT. AMT. ITPE ~ t / tW 1 / S\4 3 / Tv 311W NO. D~CtpCd+D. ~ Ar,.~W. O. n NO. OF N4N:6 ~ ~ NO. Ot NFYMAIb Oi ~NEIITGIIAI 7 ~ ri0 l~H ya 1 ~ ( ~ OTINR AMARATIK: t;.M',C. f t-1. Sf/v~~ //°/O r v _ y ~ Z SUtt'PH PARK F;T,tsC. ('QN~'k. !E ~ I+nwx rl,arx NnTCxoca~., ~Y. 11•r~z o~a~os a~ i~t(:F;NSF, y(L 373 F; Per ~ ~ Thit cartifkap mub not ba altand in airy aronmr; return b 1M, office of 1M Eoard ifintorracl. 1 may ba idEn TIIRir atlalt. ~1114~DM1G ot~ C'Oltr, Of C~RTI/Id1~ ~T..~~ ~lELD iGS:'DC:IU.7 ~~DATE ~I i;OMMENT° ~ ro a i . Gd 3 _ H - H FOUIJDATION._-. (1st) c ti FOUNDATIOIJ (2nd) ~ - - ~ 2. D ~ z ° _1 U ROUGH FRAME & PLUMBING ti r. y l` 3. ~ co y IiJSULATION PER N. Y. STATE ENERGY ,y~"`~ CODE x 1~ FIiJAL 3p~~ O o s z ADDITIONAL COMMENTS: x~ . . L Q,f' b~ x N y H O 2 l x m r \ • r H - x d ca b H r~~~ ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ROUGH PLBG. [ ] FOUNDATION 2ND [)INSULATION [~RAMING [ ]FINAL RE R 5: ~~ti~~ p~ DATE ~ ~ U INSPECTOR z 83 Ave. uC r~- T 9.v /1/ew yv2 ~ ~ /OOG 9 ~ v~ /y~, / 9 ~ 9 2 7/JBMyJ' ~/~/ir ~P,c„ , iCJvI ~~/NS fi-~f~/JR /In PNf ~/rJ ~/N HAl/ ~{'I Sa~ r'~-~.~//J, y i/g u!lIJJJi~, ~ /~JG I s ~e.a2 / 6,+~ ~ BLDG. DEPT. ~ TOWN CF SOUTHOLO o~ m~ u. As fc „ tid w ,0 7`e,~ ~...-:-eo 6~ .Qe ~ ~ 1.e.a..~~ . f ~P y I'~ ~,,cq / ?G /n.e A clirv / f'o.~ ~9 A~< Ft ~~.c w/c~~,V/ / n% .f~/eTc / i/at'~J o~ y o f 7`+.P ~d ~~o c.~ /n~f ~in e/J ~ h , c h /h / S !1 I JJ/2 C o IN/V F N / P ~v ~ 2 ~Q ti .5 ~1 ~h R,~~ M col y nos r~ K ~e P ~vss+ G /.v fr A 2fJ .u f e in .eri/.r , O~ .a N~ 7`int A~7`t'.4 Oct, /U T.i/aa.~~ v~Rr Mac /C / ' /YI/CH,^.E'L T2/~/~T~'/Cep 9 ~7~ .dos ~iQA„~ •.~ers~,r-a-. / - ----(J ,ty~ - I~-e c..o ~ ~ ~ v ~ Q ~ 'moo` ~~a-u.~c.~nc. J°"„' ? ~ _ ~,a'.. 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R .'e 10 _ i ~ i ~ 4 ~ _ ~ ' ~ ~ I - ti~v+'.-co'~T 4 ~.e~''~ . ss; vas I ~ 1 a 1f`• ~ ZKL = ~ t' i + yz ~;a~> . , ~X b ~ ' ~ ~ ~ ~ ~ "'w .b.'J ih~ ~Vi°'' 1 ~ iT E ~._y~~~ r~~-~~:w ~ ~ ~r f ~ i t z.,,, c...h r j ~ , G~~~ ~p {v1u;4R~ Z~ O` x"L~-O`•~ty- ~ - 2,.K K j ~ X A~ ~ - ~ L1cl ..,aq t - 1' . _ _ . ~ Y~'.~ 5~~~~.~y~-Tee F_f ~ ~<,.~~I i~ ~ ~ _ ~ ~ ~ ~ , ~ ~ ~ , , ~ ~ r , L pin PUG p P'r Q^ c~ ~C° ~q GC~iO .a aS3 ~ ~ rj~ ~f~ G~ O^ ~ PS ,q ~f~ ~ po. C 1~ ' P / 9~ ~ ~ / ~ ~ ~ ~~t~~ ~ Q f1 M19 T ~1 e \ $ 99j~ ~ ~ ~ i~ a00M ~ y ro, m s •v v 7 f 0 0~ wv~ b_ ~ f'~ I(wJ `A'FC ~M. A \ r \ ~ N ? Q Ff v .~j.a f i40 <e v tie ~ / TA ~ A ~ s ~ ~ 6'c 0 / ad,3 i 5, y 00 c~ i.. 2~~1 C7•• i `7 ~°b~ / 6 ~ . ~ ~o Zb n y T m O O C A <A I_n < <p < N- N N~ N p N U 90 Wg' pNppp~ i0v ~ Jb Z apJ V~~+A A'p N (1 0 1 ~C ion M z 2~ m m O m ~mz cn 0 D o F C fTl -ri 2 . r tn{ i~ O Q ~ ~'I~ AM~ o ~P r C C z m Z o O_ T. -1 ~ N z ~ o ~ ~ r ~ m mNi f S Z1 = ~ ~ 11 Y D L O Z ~ C7 0 0 0 D ~ i ~ C M ~ m D ~ ~ u ~ Z D ~ ~ ~ ;i-.RgS~ (/~J (~'jj '•4yje f, z ~ x z 1~ ~ s ~ ^ ~ N ~ _ i/ l4! C.:.]. µ K i~ K Z O Rl IO 2 ~ ~ ~ ~ r ~ Y y n ~ r+ ~ D 999 C `G O ~1 ~ o ro 9+s mkt ~c~r~ rwA ~ ~n ^v ,kL.`'3~£m <o~ x n ' arry;vF 0 ~CD a ° z c, o ~ ~ 'v o ~ a - ' D -n m z'~z.=pc z m C IO c i o n ~ v ~ w ~ r0 i ° , Ih a ~ B0.1RD OF HEALTH FORM NO. 1 3 SETS OF PL.1~ ,yyg3 , • ' ~ ' SURVEY TOWN OF SOUTHOLD CHECK , ri'- BUILDING DEPARTMENT SEPTIC FOR;f ~ ~ T04VNHALL EOUTHOLD, N. Y. 11071 NOTIFY /y ,p~ TEL.:7G5.7302 ALL ~~r~J`~7~-~~~j Examined /'~~!G,,,,,,,. 19Zr?/, MAIL T0: ~(J.~/~, • ,lpprot~d 190/. Permit No. h ~ ~ V L5 Disapproved a/c V ~ i~ ~i~~ ~ u ~ BLDG. pEPT. . Buil ng nspcct~ • • ~ • ~ ~ ~ ~ TOWN OF SOUTHOLO APPLICATION FOR BUILDING PERMIT Cp Date ! U ~ L........ 15'.g INSTRUCTIONS a. Tlris application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with :'ets 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 street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appL ration. , 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 Pcrmtt to the applicant. Such permi shall be kept on the premises available far 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 Occupant} shall have been granted by the Building Inspector. APPLICATION IS HEREBY hfADE 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 Yark, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. rite 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 ins trio s. (Signature of app}icant, or name, if a cur oration ~rP3 ~vE "c' ~~T~ g~ p ) _ (1<lailing address of applicant) Mate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...........©cv` n.i'F.~ \ameafoa•nerofpremises .1~'11Ct!"aE+-- `t "~T ta^i >r ..'~.lT'Z~//~Tt2iL_ k';,..••.•.••.•••.••••• _ (as on the tax roll or latest deed) ~ ~ ~ ~ • :f applicant is a corporation, signature of duly authorized officer. ....................l~..t~,...................., (Name and title of corporate officer) Builder's Licanse No . Plumber's Liccnsc No . Electrician's Liccnsc No . OtltcrTradc'sLicenseNo, ~a S i Location of land on which proposed work will be done. , , , , , , , , , f~2 c~r„~, ~ 1~",~ ~ ~v~l »R..(...~...~? . 4:.... house Number •Strcct Hmnict " County Tax ,.\1ap No. 1000 Suction , , Block ) I Lot. ~ Subdivision . N `t • • • • . . Filed ~fap No. (N:nnc) Lot............... State casting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ ~ b. Intended use and occupancy C.T. Y'.IL.??~,2~.:. ~o CL.~. z~.0 ~,l? ; , . ~,0 4............ . - i - 3. Nature of work (check which applicable N Repair , • , , ew lluilding ' • Removal Addition .Vterauon ' • • • • Demolition Other 15'ork . • 4. Estimated Cost , , ~ ~•O O • ~p:ser` " " • PUb7 Fee.... 5. If du•clling. number of dwclljng units , , , , 0 ito be paid on films this a If g PPlication) ara,c,numbcroCcars Nnmbcrofdwcllingunitsoncachlloor..,,,,, • 6. If busyness, commercial or mixed occupancy, s ecil' • • • • ~ • • ~ ~ ~ ~ ~ ~ ~ • ' ' ' ' ' ' ' ' ' ' ' • • • • • • ~ • 7. Dimensions of cxistino structures, if an FranP ~ ©anyrc and extent of each t riiu~ ~ ~Qv S, Height ..:~;;Q Y' Ypc of use .Ni . . . Number of Stories , , ,Z~ • • • Rcar 2 ~1 , ~ , , , , Dtpth . , 3 0• Dimensions ofsamcst{ucturewithaltcratio ~ Depth ~ ,,,.1~. • ns ar additions: Front • . , !9, ,irr,>ti , ' 8. Dirr~~s~~•• height ...~'.~,^•,F Rear .~.~:"t~.... rrc new coristruction: Front . • Number of Stories . S,~ ;~1 Height r_ ' Nurnbcr of Stogies ' Rear Depth • . 9. Sizcoflot:Fr no ~:'•.•.~S i 10. Date of Purchase ~ /~j? 7,F; ' Rear Depth .~.o, t........ . 1 I. Zone or use district in which premises ate situated , . ' 'Name of Former Owner Nw NH• ~ ' ' • ' ' ' ' 1 Z. Does proposed cons[rucr'on violate an "4"~"~'~~ • • • • ~ • ~ ~ • " " " I3, \l'ill ]ot be regraded , , No 1' zoning law, ordinance or regulation,, . • . • . N,o ~ • • • ~ ~ ~ ~ ~ " ° 14, Name of Owner of rcmisesm,e!tAe; , PJT?•:°,rxc~"' • • \Vill excess (ill be removed fr ~ ~ • ~ - ~ ~ • ~ • • • ~ • ~ 7`ame of p lC~- premises: Ycs lv Architect . . Addressag.3. A.YE :c~:. ;vY, e;rO~O hone No.z~; 6!71 ?vo~ Acme of Contractor , • • ~ ' • ' ' ' ' ' • • • Address .Phony, No.. ~ ~ • IS.Is this property loclated with in•~~•.Address.. ••.•~••...••.'•,PhoneNo...•••~••••~••~ *If yes, Southold Tocn Trustees p 00 feet of•a ,tidal ,wetland? *YES.....t10.?~,•• mit may he required, - PLOT DIACRAbi Locate clearly and distinctly a!1 buildings, whether existin or Property lines. Give street and bloc!'; number or descri do S proposed, and. indicate all set-beck dimensions frcn: interior or corner lot. P n according to decd, and show street names and ' utdicatc whethc i, . I II ~ • T,ATL• OF \ER' YORK, ~UNT1' OF S.S . • • •(Narnc of individual si;ning contract) ' ' ' ' ' ' ' ' • • • • • • • • being dirty sworn, deposes and says that he is the applicant ~ovc named. is tltc said • • • . ~COnIfaClOf, agent, corporate officer, ctc.)~ ~ ~ • ~ ~ ~ ~ ~ • ' " " " owner or owners, and is duly a~uthorizcd to crform • P or have performed the said work and to make and file Iltis ihcation; that all statcrnems contained in this application arc true to the best oChis knowledge and belief; and that the rk wdl be periomtcd in the manncrsct forth in the application Glcd therewith. om to bcl'orc me this ..............(a .....day of... ` q a:, Public. F3~-e,~;'. , i4 : JtJ.. . • County ?ro~t4OU878~',Su~ffol ~"+lt°fppf` ~-',tr-~.,~~~y~. TermFxpirethkreh30, ~..,4./.~ (Si;nature of~~applicanq