Loading...
HomeMy WebLinkAbout17467-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218178 Date JULY 17, 1989 THIS CERTIFIES that the luilding UNHEATED ADDITION Location of Property 510 MATTHEWS LANE CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 84 Block 01 Lot 20 Subdivision conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 19, 1988 pursuant to which Building Permit No. 174672 dated SEPT. 27, 1988 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 UNHEATED ADDITION TO AN EXISTING ONE' FAMILY DWELLING. The certificate is issued to SCOTT & LINDA KAYEL (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL. N/A CERTIFICATE NO. N062094 MARCH 9 1989 PLUMBERS CERTIFICATION DATED N/A Filed Map No. Lot No. N~ _ Building Inspector Rev. 1/81 r~osas xo. s TOWN OF SOUTHOLD B111LDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NQ 017467 Z Date .....~~.~~ ................... Permission is hereby granted to; .., 19~~ ~._......... o.....,_................... ...... . ct premises located at .... .............:.:.y~:.f.,.<< ' ....(fit-r•............. ............................... .............................................G"~ f"G.~~ ..t...~~.~~1.............~.11~..,3.1~~...................... County Tax Map No, 1000 Sectionp..........(.1`^..-.7..... Block ................~.. Lot No................r?.'k? pursuant to application dated .....1..~~~ .................................... 19.~~, and approved by the Building Inspector. f OB Fee $•.• ~••~ ........ .. .r.....~ ............... ding Inspector Rev. 6/30/80 . '. "'- TOWN OF SOUTNOLD BUILDING DEPART:fENT TOWN HALL SOUTIIOLD, NEW YORK 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY .NA, "6~ DATE ................. NEW CONSTRUCTION ._.._..OLD OR PRE-E%ISTZNG BUILDING....._VACANT~ L~A.N~D...__._. Location of Property... Sfo... _- _ ~~~/~:"j:'J. _ ~Qu/~ . UOUSE NO. ~ •. STREET ~~ •'UAMLET ~~~ Owner or Ovncrs of property.,~~,Ql.~~/o.,c_,e--.~i(n,l-Y'Qi.__~ County Taa Map No. 1000 Section .,~ ! Block ._.. !_. LoC .~.~., Subdivi~io^ ....................... Filed Map ........Lot........._ PerniC :lo.O~~•'-`r~F"Date of Permit ~:01.~,-Cg~_ APPLicant ................... [Icalth Dcp[. Approval .................. Underwriters Approval.:. ,,..,.... PlanninU Board Approval .......... Request for Temporary Certificate ....... Final Certificate ......_. Fec Submitted: $ .................... APPLICANT..~CY,~C;1:~'./~~~~~G~~ ... _ . _ _ .. . ~~ 3 )771 o ~/~<~~ S~I d ~1cuL-l~re.«,Q,~ ~~~_~~ ~ reV. 10/14/88 ~• M ~ FORM NO. 6 ~ ~ ~ "' ' TOWN OF SOUTFIOLD j BUILDING DEPARTMENT ~;' TOWN HALL 765 - 1802' APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS _ A. 'This application must be filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property Ziaes, streets, and unusual natural or topographic features. _ 2. Final approval of Health Dept. of wafer supply and sewerage-disposal(S-9 form). 3, Approval of e2ectricail installation from $oard of Fire Underwriters. 4, Sworn statement from 'plumber certifying that solder used in system contains less than 2/10 of 1Z lead.' 5, Commercial buildings ,', industrial buildings, multiple residences and similar buildings and insCallations, a certificate of code compliance from the Architect' or Engineer responsible for the building. 6. Submit Planning Board~i,Approval of completed siCe plan requirements. B. For existing buildings (Prior to April 9, 1957] non-conforming uses, or buildings and "pre-existing" land ~ses: !. 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 abstnc~t of title issued by a title company which shall show single and separate ownership of the entire loC prior to April 9, 1957. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons Cherefor in writing to the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informationjrequired to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued ,by a title company showing single and separate ownership oflthe 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 in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - $usinesses.$50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificage of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 S. Updated Certificage of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.00 Commercial II Leo: 10/14/S8 ?TEED I;:S:'c^C:IU;J ~~DATE ~ %OMMENr° R A ~ 1. - - m \ ~ . _ _ Z H s FOU1dDATION (1st) - -- _ H c FOUNDATIOW (2nd) __ m 2 . _ ~/ _ 'may _ z `„ o ROUGH FRAME ~ Ij _ (~ ~ ~S ~ C PLUMBING ~ /i u . ~~ H 3 . x, chi IIJSULATI0II PER N. Y. .. y STATE ENERGY CODE ~ A \ FIi~AL z ADDITIONAL COMMENTS: ~ ~ x ro H f._ U4 ~ H YJ\ r H\ O \n Z pV ~b M r .. ~ x v m - H v ~! I y ' ~'~ N~ l '!.. ~y ~ n1 ,,. ~ ~ 1 ~.' ~ r "~ ~~~- ! s ~' ~ ~ ~ ~. U C~ ~ a3 ,~~ § a iv ,i 4, ~ ' Q M :q ~ °~~~ ~~ ~ ~ ~ ~ d. '~ `: n 1 r.h _ ~_. _ .. --._ _. _.. W.,__-..M_....._..-~,~ ......~ (\ A) n ~ ~ r. G ,~ y ~ a ~. :~, 0 '~_ `_~. to 'i~~ I r., <~ a a ~\ :l) (~~ C v~ C~ fn ,~ r''r /t ~ r~lj~r' 'JN ~a't' I ~~~~~ .___._. ~ ..__._ .e.~ t"~ ~__..._,_.,... _._.,_~._._. b 0 s ~J M f9 ~7 Sv' h~ '~G jy~. v~ ----. °~- ti n~', `_ ti . - -~ - 5" ~> :t N~ ~- ~ ~ tJ ,~ ~5a N ~; q ~c :u -: 1 1: . ~j ~_~._ " ~ y~i.... .~. 4s ~ ~ ~ 6~ ~ S ` ~ 3 w !~. +5`y V 9' ~p ____ if _...-.._,_..~.,.u.E.. - ...~..~,...~,~..~ rv~ ;~_ ~. f V," Beyy ~ L.(Y ~ ~)) ~ .~ er.5 ~~ ~ P ~~~ a ~ `L k ~ .. {•t\~ a '~ ,~ ~ "6 tin. ~ h U~ L`., ~"( ~ ~ _J ~~ ~'1 k x. l ~, _ 1~ 6 ,~.~. _........_<.....e. ~ ~ i. 4,.+ '~ p f°~ O ~~s ~~ a .~ ~~~ ,n~~ ~ z ~ „~,~ ~.~ _- ~ X 1 .i ~ ~ ~°." ~ ~ ,..~` ~• ~ \ ,~ ~~ ~. k~ ~ ~ ~ ~' ~~ ~ ~ nm. A ~ °~1 f1 -~.. Z. ?~ r... Y_ F~ ~, <, ~~~ ~. ~ ~C ,. ~~ j 5~ ~~ ~ fi ~' ~ ~, a ;~ ,: ~~~ e '~ ~: ' i', o g. .., Ut "~ds j`'' ` „-a nee ~ ~ ~~f 0 C ~ h~ ., ' ~ ~ ~. ~.n ci ~ fi, s ~, ~ ,:,~ ~- ' cv /1. y ~ `~ ~ ~ T.r' ~~ ~" _ Qi ~ y d~ 3 /~ 1 I 4~ ~ § e~r`~ ~ I ~ ~ ...._ a te;' 0..i r "~ w3 ~ z , , ~ ~ ~ e ~.. 2~w_ ~)-~ OF ~~ ~ ~ .,,~ ;~ ~~ ~7 to L° ~-, ~ -~.. ~ `1(' Cn A \~ ~ ~ 4 ~ 'w f^ ~ r~"1 C+ .~V n r'= ~ ~ :.> "'' ~¢ ~ ~ X ~ = r7 n n ~ __.___.w ' a ~, '~ '~ a ,~ ~ -~. ~'' 1 !~ n ~ ~ ~. ~ r i ._ ~' ~' c -~ ~ ~ i ,~ 4 ~~ Q B (~ ~[,~ a, ~y1~ `~ »`q ~' C' ___e~___..~.~.~..M~ _ _.•~/^' ~\ a r;;'_'w. ~~~ ~ - n ~ +-9 rat" , ~~ ^^i/ X ~~ "K k, ~e ~~. r\ ^. ~ ~ ' ~ v,, G`~ ~ ., ~.;a ;~~ L~ r5 ~ ; , , L P° ~`~ .~~ f,,~ ~ 4, ~~ °~` ~s ~' „~ ~, x~ \~ ~t r g r v ~, ,~ .~ ~, rtE ~,,. f~ ~;, ~~. 6°{j _ 3 _......... ...w......._.. 7.«....... -~ ~! ~ r Y y i y hi ~~~ ,~ iS Nom, ra t~ l7 f , u ~- -C, , 't, ~'`^= ~°n a.~ m~ ~ ~ .nj ~ ~~ .~" ~3. ~ .i. ~ .~ ~~~~ 193 ! ~ ~,~,,' s_a '~ ~ ° ~,~ z '~ ~- "~_ res _..,_ __ _.... . ti . ~ ' ~ a~ ~-, ` a m _' ~~ ._ ~_ ~~ ~ ~ Cl a~ c f k ~ _ ~° ~ , ? ~ ~ , ~, ~ -y i ~ i e ~ }: \ ~^ 41 L \ ~~ +\~ ` ~ ~\ n ~~ ~~t a ~ C~ ° ~~ ~~.,. ~a a~~ ~¢ ~u ~` ~° ''°~ r•n ''e*. ~~ ~ " ~ ~,, ~~ r, ~ ~. ~ ~ ..,_ ~"a p^g ~s>- ~' ~ ~ ,,,, ~ ~ t,,; 4 ~~ 1e ~, -•s ~., n ~~ ~ ~ ~ ~~ ~~ ;~. t~ ~' t-' ~~ ~~~ ~ r~:~~z~ BUILDING DEPT. 1 NSPECTIO~N~ ~ ~ ~~ [ ]FOUNDATION i5T f ] ROUGH PLBG. [ ]FOUNDATION 2ND INSULATIOt+I [~RAMING [ ]FINAL REMARKS: ~Y~~~-~~~--- '~~ ~-'~vd-~~..~~~; f~._ DATE /~ ~ ~ INSPECTOR I._ . C7~~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING FINAL DATE `~ ~! ~C INSPECTOgt ~~ `""v --~ 65-1802 UILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ J FOUNDATION 2ND [ ]INSULATION [~MING [ ]FINAL DATE ~~ ~~ INSPECTOR ,. REMARKS: ~ ~~~ " ' " ° THE FLEW YORK BOARD OF FIRf, UNDERWRITERS PABE ! 1195112 ~ euREwu of e~ECTRtcrtY SS JOHN STREET. N!W YORK, NEW YORK 40038 Date NARCN 09,1989 ApplicotionNo.onfile 59452588!88 N 062094 THIS CRARTIFIES THAT only the slectr4ef equipKwent v deecrfked fMdow end introduced hY the applicant nomad on the sftooe spplicetlen number ira tha premLse 4/ COTT KAYELr 510 NATTHENS LANE~~yy,--~~CUTCHQBUE, N, Y. in the fo!larcinE loc n B..e t L~ /At Ff. ^ Ynd F1. SerNon Block Lot RUAtfV 24,~~89 uNU esemined un end found to he in rnmplFanre with the requirements of this Boord. MXniRe RAN ORf WORNt ®RECKS OV RNS DISNW Y ST FANS OUTIlff AcLEf ~~ I rrCANDtaCLM nUOSHCLM OTNER AMT. K. W. AMT. K. W. NAT. K.W. AMT. K. W. AMf. N. r. 7 2 7 RIRf1AtX MOTORS IY}Y4 A!lIIANCE tEEOMf SHOAL RELIT iWRtxOC[S yLL 1NN41MA49S (AIA44011T1lT OItAfARRS AMT. K. W. Oll N. r. GAS M. r. MIT. NO. A. W.O. AMT. AMO. AMT. MNS. }KANS. AMT. N. r. ~. Qf t~T AMT. WATTb SMVIR DlftbNINCT NO. W S E R V 1 C E AMT. Mq. T1rE ~ 1 N tW 1 / tW S / tW S X ~W W.OF CC. COW. rFX / A. W. NO.OF N4ltG Or CC COND A. W.r.~ Or rIF1EG W. Oi NFInMIS A. W. G OF L TM . . N G I V I~RR MAIVI,YY. 5PA N/60 AMP DIBC-! t. / 5A8E & l.AOEHANN INC, l[[;.R3635 E F. U.80X 1768 SUUTNOlO, NY, 11971 Or! ytp~ 1t Psr~ Thit certificate molt eot lice ohrNld is 4n)' mariner; Mlrm to the office of the Board Ff intornet. Mtpectors moy b• identified Mt+ir cndemiok. COPY POR.:#iM D~[PARfi11EN'T. THIS COPY OF GEIITIFICAT# AMKT MOT 6E f1li`?ERf,O IM AlI1L ~Ai~MiLiF. >. . ,~~_.. _ ~ ~ =` 3 ,~ g~r r~ sy S tp - ; ~~ °l' . ~ x ~ ¢ r r 1 ~~'~ r; ~f ".r;r. t i ~~~ r ~ ~~ r ~: ,y,~ u' S ~(?i f s c` i ra j x pr hh ~ g ~ l ~b x~ r~ ~i ` A x ~. (.y ~ N j ~. .O, F ~ ',;Y~' w ~ "~'t ' , p; f ,1 !,. #7 :£ { ;, .~-.~ ,' ~ ~~y •~~ .i, ~, ~ B So~z N ,~,`~ •M ~Z' ? "a r 's. ~ m o `w ~ o ~ ~ ~ ~ ~~° y£' ~ N. ~, ~omz-r K°v ~n r ~ ~r ~ Y,E '~ ' .-~yzo zm y ~ .. ;~~~A z~m<-~°s wpm c3 ~ ~\ ~.._ 'ky~ :~ ~~I. _ ri~..~^ .>"_ aym°m amz~ $aS 7e ~ p'al eo~'Y $a'oi zd °'~amn nm x-r i<^ t \ ~ ~' e ~ O 'a~~,1; 'r,~y ms r x m' ° ~ k ~- ~ ~ ~~~ a xm°n.°°zm m>a!< ooa ~ ~ +. ~ ~ \ ~ '`~-ice ~.. min O^a," az ~~iL y~~ (n P r~ r-, z°n °c° m rmo z~ ~~~ ~ C r. "~_ y-nmcm zr~ ° ^ ~ w y?y ~ oo'~rmi,Si,;-„ii m '6 °in b ~ i~. TTT.. ~ f m~'^Qix imis ir'n ~~y N `. ~ 4 ~ ^ .'a i m m o w z a m z° z~ 4l p f H tp ,A .:;j; C ~ '~~ A O`V .4f t p ~ , YJ '~ - f .,~, 1 l o a r, 3 n z ~ w c~ 1 ~ ~ fl ~ W O m 0 1 ~~~ ~°a~ ~p ~ ~ (~ c xor - o 2 O~< °mm ~ +~ ~1 ~ r~,,m ~qz _ .P 1 I '1, T ~ ~ V~~ or0 a ,~ O ~ C ? n C a -. ~" au;, x n =n .Z~ N c \ ~ - n0 Z Q ~ ~ " "n --+ o pZ 80 *S ~p z O C Z 11 z o o '~ °- 8 "~~ m ~ ~ O Z N A C ~ ~~~ \ ., by 2 ~~~ ~ y, a `~ m ~~~ ~~ ~ ~ ~~~ f-~ m y c ~ ~ ~ ~ e x ~ ..b w.,.,„, ~ i= (~ M '~'~' n q Z m~ O.r r - '. 1 a .Z , Q y N,rM, ry0 '~ 0 ~ ^i p M ~ 4 ~L ~a ~ ~ `.~ o N _ '~.~ , ~ { ., ~ .r ~ 2 ~ i ,~ ~ OaIO _ ' t. ~ :~~,~,~' ~~, M ~ °k~, H `o oaR. yAFn x§ F ~,.~ ` ~z ~~ '' ~~~ ' ,p 'J~~O~ y,m C rn~ ' ` 4 '+~ 1 f ~} ~, M1 _ ~ ~ r_ 1 C t N ~ ~ ~ t ~~,tr~ ~~,3n~~yp r i 4.~'i CS 4 fh AA'Y BOARD OF HEALTH .../.,.,,,,, 3 SETS OF PLANS .......... FORMN0.1 SURVEY ..... ... ... .. .. . ' TOWN OFSOUTHOLD CHECK ...~.~©tP..~........... BUILDING DEPARTMENT SEPTIC FORM ................ ' TOWN HALL SOUTHOLD, N.Y. 11971 N~ ~- TEL.:7G5~1802 CALL MAIL T0: Examined ..~ ..oa.1'. ~....., 19 ~GG ~ ' Approved .. ~.~......., 194~Permit No. ~ ~~'~~~ Disapproved a/c ..................................... ........................... o (B rn Inspector) APPLICATI N FOR BUILDING PERMIT INSTRUCTIONS Date .~.~./ ,1........., I~U. 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 construct'pp~~, € buIldittgs, additions or alterations, or for remova e herein described. The applicant agrees to °~d~t}1riLt~t=h atl applicable laws, ordinances, building o ousi de, an reau tions, and to admit authorized inspec+ toffs, o~;pr~Tnises and in building for necessary inspectio s. ~~a, ~ ...:. ~. ~ ... :~: .c • '*"%"° a~~fi3F-l~.l~~ ~ (Si~natui of applicant,~orhar e a corporanon) z€i 1a5~..~ ., r~, d,.:; s > .7~.~+ e ...............f.=,t. .............. ........ . • 6'4'Iisti9ti£l~ t?'~ ~"t (Mailing address of applicant) State whether appjjggnt~iS.b'~v~tei•~"1'~s`s'ee,.agent, architect, engineer, general contractor, electrician, plumber or builder. . ... w....... .. Name of owner of p6'$tlf~esi•;~~! ~Oi]# 1 ~,{ 1 .:. • : ~•' • 1~..~~1.~•~ • • • • • • • ...... . Y.M3 't ~ ,pt .t~.,<,e; ~ - (as on the t ~ ,~y~~ If applicant is a corp~~ior~pr]'ie'of duly~autli"oriied officer. V1~4i~~ (Name and title of corporate officer) Builder's License No. .... ~~~..~~........ Plumber's License No . ....................... . Electrician's License No . ..................... . Other Trades License No . .................... . Location of land on which proposed work will be done . ........................... . ................ House Number Street Hamlet / i !~ I",~' I ~ 9 ~ (~ S County Tax Map No. 1000 Section ...... ~-1.......... Block ........ !r......... Lot ...,~~ , , , , , , , , , Subdivision ..................................... Filed ~fal~ No. .............. Lot ...~ ........ . (Name) 2. Slate existing use and occupancy of prerniscs and intended use and occupancy of proposed construction: ~. a. Existing use and occupancy ....... ~~~:. ~ M.r• ~ ~~.. Y~ ~ l (`~, , ~, Intended use and occupancy • • • • • • • • ,50.h ~• • • ~ ~• a~o ~ ~•t~ °`1 ../, U N -t-~,(YC-~,~• . , , , , , , • 3, Nature of work check which a~ ' ( pplicable): New Building ........ , . Addition .. Y....... Alteration .....~. . Repair .. . ....... ;oval .............. Demolition .............. Other SVork .....,,..'.'..... . ~' b ~ ~.- (Description) 4. Estimated Cost ......~~.:.4-~. ~. ............... Fee , ...~~ ........................... . g', (to be paid on filing this application) 5: If dwelling, number of dwellin units ........... . . . . Number of dwelling units on each floor ............... . If garage, number of cars .... . . ....... . 6, If busines grbni,~e',rl occupancy, specify nature and extent of each type of use .................... . 7, Dimensio ~~~p(r~~}~srtifttan Front .. .Rear Depth . Height .. ~ . ......... Numbs gr~'torics ............. .............. ............. . Dimensio Hof sa th teiiations or additions: Front Rear . Depth. .~, ;.~~ •l~~i~tt.. ................. ................. 8. Dimensio ~~ ~ .................... Number of Stories ..................... . nt;Front , Rear . . De th Height .. ~• Z ~ )?AT of Stories ..... . ........ ............. p .............. . 9,' Size oflot. F ..........{:..:....:. Rear ........................Depth....................... ]0. Date of Purchase ......... : ..... . ,Name of Former Owner .. • • 1 1, Zone or use district in which premises are situated ................... . ... • • • • .............................. p p g late any zoning ]aw, ordinance or regulation : ..... . .................. . 13. Will lot be re raded • • • • • • . • • • • • • • • • • • • • ......Will excess fill be removed from premises: Yes No 14. Name of Owner of remises . Name of Architeot sptruction vio Address ......... . .........Phone No. ..... ................Address . .Phone No............... . Name of Contractor . .Address .. .Phone No. . 15.Is this property located within 300 feet of a tidal wetland? *YES.. .NO.. *If yes, Southold TowrF Trustees Permit may be required, ~~ PLOT DIAGRAM Locate clearly and distinctly alll 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. ~~~ .... _ ~.~iL• ~ AS N011iD I ~~ ~~~ AII~SED /Nl, WArER ~r~l~'M CANNOr ~0 or fXi LEAD. i STATE OP NEW YORK, COUNTY OF ,,,,,,,,,,,,,,,,• S.S use-Tao2 s eosin 4"'"` "AT. FOt.LOWING INSPECTfOg R ~B t. FOUNDATION ~WORHQUIRED FOR POURED CONCRETE 2, ROUGH . FRAMING ~ p(,UM81N0 8, INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION $1igl,~, M3~ THE REQUIREly1$~ N i Y STATE CONSTRU CODE ' NOT RESPONgt~ DES1Gh ~~ CONSTYiUCryON Ei1RORat ••••••••••••••"•"""'•""~•••••••••••••••.... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. fie is the ..................... .... (Contractor, agent, corporate officer, etc,) • ~ ~ • ~ • ~ • • • ' ' of said owner or owners, and is duly; autltorizcd to perform or have performed the said work and to make and file this application; that all statements contained in this application era 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 before ma this Notary Public, ..... !; , ,1,C,., ~~(/~- , , , • , County HELEN K DE V E NOTARY PUDIIC, State o~ NewnlyYa~rkp 7eNm~Explr?es March 30 lauo,.~'-•I e of applicant)