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Home My WebLink About17570-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219003 Date MAY 1, 1990 THIS CERTIFIES that the building ADDITION Location of Property #8 KIMOGENOR POINT NEW SUFFOLK House No. Street Hamlet County Tax Map No. 1000 Section 116 Block 006 Lot 024 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCT. 20, 1988 Pursuant to which Building Permit No. 175702 dated OCT. 28, 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 ADDITION TO EXISTING ONE FAMILY DWELLING. GEORGE & SHIRLEY The certificate is issued to KIMOGENOR POINT CO.- HARRISON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A CERTIFICATE N0. N085081 AUG. 4, 1989 PLUMBERS CERTIFICATION DATED C.P. TUTHILL, INC. OCT. 5, 1989 c Bu ldinq Inspector Rev. 1/81 nowt xo. s TOWN OF SOUTHALD 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~ ~175-YO Z Date .1..~~~~... ...., 19~ Permission is hereby granted t ~ %~ ~~..~.?..~s..'9~ %.....: ..... ~ .................... ../.,r~.c.~.~.... ...~...... r/..9..~'..8... ... ... ct premises located at .. ...~......~1..~/H.ZLy/~.Pi.>! .......... ..... .................................................... ...............................................................................................................~~..^^............................................. County Tox Map No. 1000 Secti~o"n~ ........~,~I...... Block .............`4?..... Lot No............. pursuant to application dated ~...~1:.ti ~ .........................::..... 19.~~, and approved by the building Inspector. ~e Fee $...~~...~~y~. Rev. 6/30/80 - ~lt~ ~,~~~`~i TONN OP SOUTIIOLD E'""°"`"""`°' BUILDING DEPART:ICNT ~ APR Z'O19AA TONN IIALL SOUTIIOLD, NEK YORK 1 197 1 f3I.DC,. DEPY'. 70i~/SS t~F SOt1T~-i~3 765 - 1802 .a:,~ APPLICATION FOR CERTIFICATE OF OCCUPAi7CY DATE. ~~n! f.~....... NEN CONSTRUCTION ......I~.~,O/LD OR PRE-E%ISTZNG IIUIIDI,NpG......VAflC~ANT LAND_....... Location of Propr_rty..~.§,.._.._..----,,~yiliL~~-~A~QKp_4i~~_..[:P.~C1.~f:~UI~~.. UOUSE NO S BEET UAMLET //~~~mogiu~e/,~2.L~o~ni"r Cdi Owner or Ovncrs of PropertyST.2Q~?g.~:1~~,YyRI~?-e~,.~,~-~(~~~}~ ................. County Taz Hap No. 1000 Section .~~(!!•, Block ..~_._ Lot' ..~:/_„_ Subdivision ....................... Filed Map ........Lot.......... Permit No. ~7s:7~...Date of Permit .dall6.~~(~ApplicaoC~'~v.~~~:~~~'~~~~~~~' a^' ....... Health DepC. Approval ..~ I.'p............ Underwriters Approval .............. Planning Board Approval ~IPr,__„ _ „ _•,_ Request for Temporary CerCificate ....... Final CerCificaCC .....---'t '-... Pee Submitted: $,~ ~ ,,,,,,,,,,,,,• /~: ~ / f APPLICANT.1 ...~ l ~ ...~ -{~.......6?~es . ~A7Ul p~VVVi~g-;t7s l~~T~~;.Uc_ ~ j y3yS~ ~/II`iG ors ~l 9pD 3 re°• !O/14!88 1,.1 n. S _ 9~ FORM N0. 6 ~~~ TOWN OF SOUTIIOLD BIIILDING DEPARTMENT TOWN IIAL, 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUGTIONS A. B. C. D. This application must bel,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 lines, streets, and unusual natural or topographic features. ' 2. Final approval of IIeaXth Dept. of water supply and sewerage-disposal~S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from dumber certifying that solder used in system contains less" than 2/10 of IZ lead.j 5_ Crnamercial bnil.dangs,',industrial buildings, multiple residences aa.d similar. buildings and installrttions, a certificate of code ramplian..e from Che Architect or Engineer responsible for the boil"ding. 6. Submit Planning BoardjApproval of completed site plan requirements. 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, 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. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to Che applicant. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent information required to prepare a certificate. 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 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 in writing to the applicant. 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 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwellivg - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Cert}ficate of Occupancy - $20.00 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy -$15.00 Residential Commercial eo, 10/14/S8 =lELD IGSPn =u;+ ~~UniE ~I i;OMMCNTS ~+ ~. '*~ ( ~ m a ~ H C cOUNBATION ( t) ~~ c ~ -/ FOUIJDATIOtJ (2n~f) _ ~ 2 of ~ ~ idz z o p // ROUGH FRAME & , PLUMBINQ' ~' Z "~ f ~ ~ 1--~~\ el3 Q ~ ~~ z 'C 3 . ~' _ ~ ~ - m c~ IIJSULATIOPI PER N. Y. .,~.. ~ $ ~ y STATE ENERGY .-~ CODE ~~ x_ 4. '~ y `~~ FIidAL /~1-z' ADDITIONAL CO ENTS: ~~ ..~ ~; • __ ^o '~ a ~'' H H O C'1 i p [ '7 . b -1 ,, ,~'r~FFOL~f'C~! ~ z/~' ~l ~~ r. ' t ,,~.~~ ' ~- o ~,,, ;~~~„< <;, Y ~i~~l ~ ~bo TOWN OF SOYJT~Ob,D OFFICE OF IIUILDIt4G INSPECTOR P.O. BOX 728 TOWN HALL SOUTHULD, N.Y. 11971 C E R T I F I CAT I O N TEL. 7G5-1802 Data ~.. ~. / y.~ f Building Permit No.'~'1 ~'~ ®~ Owner Cg,.o ~ n ~~I~Y1 ~2 c ».~ (p ease print) Plumber 6. P. Tuthill, Inc._ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. s~ i vG•vG%v~ ~9~~ plumber's signature) Sworn ,to before c this day of y[~~~,1J~ . _, 19 ~ `, tlotary _..~~:~~ ~ --=G - Notary Public Public, ~ aunty ' tdo+~rf u'~rr,B7.~ A. A9A ae 6 / a Yorh Oar~r,i.,l.~riJl;[,%r~s t~ angt ~ (~ f /cP.OP/1(~it~~ ~Lte ~Q,~~ r,~e ~a~ad~~~Gh~,~e ~cr~ivte Environment East, Inc. R. R. No. 3 - 3075 Indian Neck Lane Peconic, New York 11958 516-7347474 November 11,1988 Southold Town Building Dept. z'own Hall Main Road Southold, NY 11971 Re: Permit # 175702 Harrison Residence To Whom it May Concern; Enclosed are pho..o for reference on the foundation inspection on the Harriso resi ence at Kimoginer Point, New Suffolk. Sincerely, Feter R. Stcu~ dburgh President Environmen East, Tnc. ~ Encl. PRS:jm %-,- Locate cleazly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether tenor or corner lot. 6b~6~~ -~-- -- ~ I ~XlST1NG i L'NISSIN4 a ~L-___ o coNCRI-"1'E PhT~O 9 PAT\0 ~ PACCU ~EMENT Lj\.OCK ~q/AIL. PRc~lays~p PI-AN V1G~n/ SCALE I ~~ = 2C~' _1 ~~ ~ `F 1~ n~ -~~ ~ //U- ~U(llr '~~~~.' R /~P,dP/Zh/Lt~ ~' ~~- ~a~ad~~a~r~~ ~e ~r,~e Environment East, Inc. R. R. No. 3 - 3075 Indian Neck Lane Peconic, New York 11958 516-7347474 January 24, 1989 -~"" ~~ fir.. ~~~ ~~ , Soi.itho]d Town Building Dept. ~ ( ~e~~~l ~~.: '7'c>wn Had], ~" t ~ ~ ''3~`I). Main koad ~'~ Southold, NY '11971 I" ' ~? Rec Permit # 175702 °. °=,'+"`+~a~~,-<i;t ~ ..~ - . ?~t ~~ Door Sirs, Enclosed is a copy of the manufacturers specification on clearances for the furnance installed at the Harrison residence under. the above ment`i`o/fined permit. Please inclu this iytformation with the permit. 'Phanlt you. % ~ a Sinrex`eay, Peter R. Stou enburgh President Environment ast, Inc. Encl. P R 5 j m ~ ~"' "~.. r~~?J`V ~ '~ 18-CB13D1 2nd Printing, 19$3 Elite Gas-fired Recuperative Furnaces (BLU,BLD040,060,080,100,12~i-8) FOR YOUR SAFETY Do not store or use gasoline or other flammable vapors and liq- uids in the vicinity of this or any other appliance. WARNING FOR YOUR SAFETY If you smell gas: i.Open windows 2. Don't touch electrical switches 3. Extinguish any open flame 4.Immediately call your gas supplier. • 20084 142-R2 December 1993 "` `` • ` ~ALLATION ;RAL INSTALLATION INSTRUCTIONS: ,,nanufacturer assumes no responsibility for equipment killed In violation of any code or regulation. The opera• Jnal portion of your manual will Ipstruct you In the service nd care of your unit. Have your Installer go over the opera- ~tlonal portion of your manual with you so that you fully understand your warm air furnace and how It is Intended to function. N is recommended that Manual J of the Alr Conditioning Contractors Association (ACCA) or A.R.I. 230 be folldwetl In astlmating heating requlremante. When estimating treating requirements for Installation at altitudes above 2000 tt. remember the gas Input must be reduced (See GAS INPUT ADJUSTMENT). Locate the furnace as close to the chimney or flue as per• miscible and as centralized with respect to tfie air distribu- tion system as practical. A gas-fired furnace for installation in a residential garage must be installed so that the burner(s) and the ignition source are located not less than 18 Inches above the floor, and that the furnace be located or protected to avoid physical damage by vehicles. Take Into consideration all clearances that are required A. Clearance from combustible materials (See IN- STALLATION CLEARANCES) B. Clearance for service accessibility (See INSTALLA- TION CLEARANCES) C. Clearance for combustion and ventilation (see AIR FOR COMBUSTION AND VENTILATION) ~ D. Clearance for attaching duct work (See DUCT CON• NECTIONS) E. Clearance for proper installation of venting (See VENTING and CONDENSATE DRAIN INSTRUG TIONS 18-CH13D1) _ F. Clearances for any eMernal filter racks or sub-bases to be used. G. Clearances for gas piping (See GAS PIPING) H. Clearance for running condensate drain to the floor drain (SEE VENTING and CONDENSATE DRAIN INSTRUCTION 18CH13D1) The Installation must conform with local gas company regula- dons, national and local electrical codes, local building, plumbing or, in the absence of local codes, with the latest National Fuel Gas Code ANSI Standard 2223.1.1980. INSPECTION AND'HANDLING: Material in this shipment has been Inspected at the'factory and released to transportation agency without known damage. Inspect exterior of carton for evidence of rough handling in shipment. Unpack carefully aftet moving equip- ment to approximate location. If damage to contents Is found, report damage'immedlately to delivering agency. ORDERING PARTS: When ordering shortages or damaged parts, or when order• ing repair parts, give the complete unit model and serial number as stamped on the unit nameplate. Ortler all parts ~Jpflow models are A.G.A. design certified for installation on combustible floors and for closet Installation. For Installation on combustible flooring, the furnace shall not be Installed directly on carpeting, tile, or other com• bustible material other than wood flooring. counterflow) models are A.G.A. des gn ce fled for installation on noncombustible floors and for closet installation. For installatfonbn combustWle floor use com• bustible floor frame, see Page 5. Combustible floor frame must also be used when cooling coil and jacket are applied in Installation on combustible floor. The following lists minimum permissible clearances to com- bustible malarial, for all models of recuperative gas furnaces. Back Front Top of Plenum Slde 1" 6" 1" 1" ACCESSIBILITY CLEARANCES MUST TAKE PRECEDENCE OVER FIRE PROTECTION CLEARANCES. Minimum accessibility clearances are as follows: 1. 24 inches at side where access is required fdr servicing and cleaning. 2. 18 inches at a side where passage is required to another side requiring servicing or cleaning, or at a side requiring inspection or replacement of the flue connector. 3. In utility room Installations, the door shall be wide enough to allow the largest furnace part to enter or to per- mit the replacement o} another appliance, such as a gas water heater. 4. Where external filter racks are used, clearance must be provided for removal of filters. The furnace must be installed on a solid surface and must be level front-to•back and side-to•side. If this tumaoe is installed in an attic or other insulated space it must be kept free and clear of all insulating materials as some insulating matedals are combustible. It additional insulation is added after the furnace Is installed, the area around the furnace must be Inspected to Insure It Is free end clear of insulation. Page 3 765-1802 BUILDING DEPT. i NSPECTION FOUNDATION 1ST ( ROUGH PLBG. [l ]FOUNDATION 2ND [)INSULATION [ ~MING [)FINAL r REMARKS: r L~ ~~, ~` (.~~ _~~~2~ _,._.~_ ~ ~ dam/ DATE ~-~ ~ ~ INSPECTOR ~~~~ 765-1802 BUILDING DEPT. ~•r [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ___ ~~'c91, __--- -- - DATE ~~/~~ INSPECTOR / ~ s'~v ass-isoa BUILDING DEPT. INSPECTION [~j FOUNDATION 1ST [ ] ROUGH PLBG. [ v]~FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE !/ /~ ~0 INSPECTOR 7tP.5-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ INSULATION [)FRAMING [ ]FINAL REMARKS: ~~ry -~/~~ ~ / ~r ~O DATE ~~ INSPECTOR i .. m _ . , THE NEW YORK BOARD OF FIRE UNDERWRITERS "'"~~ ~ "I-~}ll l~~~f~; BUREAU OF ELECTRIGITY 88 JOHN STREET, NEW YORK, N - ORK 1Q038 A[Ia,t,rS'~" ;)9, i')8SD ~~'~57i1£t, #? N fR5€~R'i Date Application No. on file TF115 CERTIFIES THAT only the electrical equipment oa deaeribed below and introduced by the applicant named on the above application number in the premiaea of t~[R ts;a?t?7SUIV'. Ia Rl:~t7r~i"rrN'te f~r,~>llv9°. P4t:;I7 Sr.tt;~k't7i~K, 1~L"`i~ in the following Iocatf~'rn~~ ~pyslglnent ~ Iat F'l. ^ 2nd FI, Section Block Lot was erarnined on aced found to be in cornplignre uith the regairerreents of this Roard• iIXTURE OUTLETS ECEPTACLES SWITCHES I FIXTURES NCANpESCENi FIVORESCENT OTHER RANGES PMT K W. COOKING BECKS AMT K W. OVENS AML KW. DISH WASHERS AML K W EXHAUST FANS AMi. H P. <~ ; 13 ~ a DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MUITI.OUTIET DIMMERS AMi K. W. Oll H. P. GAS H. P. AMT. NO. A. W G. AMT. AMP. AMT AMPS TRANS. AMT. H P SYSTEMS NO.OF FEET AMT WAIIS "I l' T, !l{~i SERVICE DISCONNECT NO.OF S E R V I C E AMi. AMP, TYPE METER EQUIP. I ~, ~ ~ ~ DW 9 ~, ]W 3 ~, dW NO, OF CC. COND. PER % A W G. OF CC. COND. NO OF NbLEG A W. G. Of HIAEG NO. OF NEUTRALS A. W G OF NEUTRAL OTHER APPARATUS: Gy A)RTY yyyy~~~9T)T6pp7yyt(tyO~ yS SK'i', { AQ L,V 5'A~.liV n)li3J3J }All. CIiTCIIf)GUhir DIY, '9193Ci ~R~.E%rc-vt.iC!~~~~ GEFIER#l MANAGER zt ,z Per ,~'Z.- ay be identifi ii by their credentials. Thi6 certificate must not be altered in any manner; return to the office of the Board if incorrect. COPY FOR BUILDING DEPARTMENT. THIS FORM N0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 . xamined . /.`~y/.~. O......., 19 O.T7 pproved .~/.~......., 19 Permit Nol ~~7d isapproveda~ .....................~............... ...... .. ............................,~r•,...... r APPLICATION FOR BUILDING PERMIT INSTRUC~TIO'NS 3 ~ ~a~ CPS ~~ A~a~ta Received.. ..,19... Date .. O.e,tobex .111,..., 19 .$$ a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 is rf 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. 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 all 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 all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depaztment for the issuance of a Building Permit pursuant to the iilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ;gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspections. ,..,'nvirgnme,nt,~:,ast,, Inc,,,,,,,,,,,,,,,,, (Signature of applicant, or name, if a corporation) 3076 Indian Neek -,Lane • • •Becanie• • •l~dY• 11958 ....................... Mailing address of applicant) :ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricsan, plumber or builder. ........Gaper.&l. Ca.ntrya}~.tor ................................................................. ame of owner of premises ... t.l.I!tTW~~/rai~. . ~P .:............................................. . J {as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. Pre eident ............................................. _ (Name and title of corporate officer) Builder's License No.555b, f1I ................ . Plumber's License No . ....................... . Electrician's License No . ..................... . Other Trade's License No . .................... . Location of land on which proposed work will be done . ................................................ . ...~8,,,,,,,,,,,,,,,,,,,,,Kirno~ine,r,Point,....,,,,,.,,,.....,,,.1V~w Suffolk ........................ House Number Street Hamlet County Tax Map No. 1000 Section . , , , 116 , , , , , , , , , , Block .... 6 .............. Lot .. ~4............. . Subdivision ..................................... Filed Map No. .............. Lot............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy~ne.,Family.Dwellin~ .............................................. ~.~~ b. Intended use and occupancy .. One Family dwelling with ad.dit,~oti~ .,~; ,,,;:. ~-,»:,;,•~ .. ~ ~ _,;; 3. Nature of work (check which ap' licable}; New Building .......... Addition ..`X .... • .. Alteration . • • .... • . . 4 Repair .. . ........... Removal ......... • .... Demolition .............. Other Work .. ........... . (Description) .~ 4. Estimated Cost ./,.~~,0~.... ........ . .............. Fee ... , ................................. . (to be paid on filing this application) 5. If dwelling, number of dwelling units • . ~... • .... • ... Number of dwelling units on each floor ............ • .. . If garage, number of cars .... ............•......• ... ......................... .......•...... ,. 6, If business, commercial or mixed occupancy, specif6~~ t~u~e and extent of eac}r-t~g~~of use • ..... • • 6' 6 ~'' ' ' ' ' ' 7. Dimensions of existing structure, if any: Front ... . , ... • Rear , ..... ...... Depth • .. 3.. • ....... . Height ...... • ..... • .. Number of Stories ....... ~-. • ... • ... ....... . • • . • ... ... • . . Dimensioc~c6o~'~S~ne structure with alterations or additions: Front . , 68!•4'1 • • .... , , . Rear . . ~$.r.4 ~'...... . Depth ........ ... I .Height ........ ........... Number of Stories ... ..1.. • .... . 8. Dimensions of enti~~;ew constryction: Front ...~tl!'.. , ..... Rear ... ......... Depth .. • ..419:'• ..... Height ................Nu~f~S'ofStories......1....................................•......•..... 9• Size Qf`lo'~: •Ftorlt: `~~ };.;"; .. i ....... Rear ...................... Depth ... • ................. . 0. Date ~~11:h.~h~~~`S.~':"1N.{,:;'~~r`~„~~+~ ......... ... Name of Former Owner ................ . . • ... • ..... . 1. Zone or use district in which premises are situated , . Re s•1d a nt:i al • • • • • ........ • . • • . • . • ... • • • ..... , .... . 3, Will lot be regraded ate any zoning ]aw, ordinance or regulation: ..... No ........................ . 1. Namepof Owner of stremises Kirrj ' ~ ` ' ' ' ' ' ' ' • Will excess fill be removed from premises: Yes No P ~ofginer..Eoi.nt .CAJdress I£imogi.ner. ??•caia;7. Phone No.. • • ... • . • ..... . Name of Architect .......... .............. .Address )'Ie ur. Su.~~4~k,. ~X. la'1tbA~$~lo. ..... . Na,neofContractorEnvi,r,onma.rl~.k,.OSt,.~.rl4.Address 3.0?~„ I,ndian Ngc one No734`.7,47~I-....,.. Peconic, NY •119~~ PLOT DIAGRAM Locate clearly and distinctly all''~buildings, whether existing or proposed, and indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street games and indicate whether t~tior or corner lot. 'ATE OF NEW I2 WNTY OF .. ~.~ ~'S ... • :~~• • • • ~•wr:"°4~ ~ ~.~.. , . being duly sworn, deposes and says that he is the applicant (Name of individual signjng contract) we named. ~ is the ..................... ... ...... ...•........ .• ....••....•...........•....••. (Contractor ~ gent,.corporate officer, etc.) said owner or owners, and is duly authorize to perform or have performed the said work and to make and file this ~lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be performed in the manne;t set forth in the application filed therewith. om to before me this ........ ~ ~~C day of,.. . ~.;/. ..... . tary Public . ~.,Q/,t<e.. `;},~: ~'~tCf ~~~. Cour CIAIg6 L QLEW NetaryPubib, State d NewYMk of applicant) No. 4878606 _`~ tluslHied in Suffol~C County C,N Commission Expires December 8, t9