Loading...
HomeMy WebLinkAbout17585-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217510 Date NOVEMBER 14, 198$ THIS CERTIFIES that the building ALTERATION Location of Property 360 ROCKY POINT ROAD EAST MARION House No. Street Hamlet County Tax Map No. 1000 Section 021 Block O1 Lot OS Subdivision Filed Map No. Lot No. conforms substantially to the Agplication for Building Permit heretofore filed in this office dated OCTOBER 31, 1988 pursuant to which Building Permit No. 175852 dated NOVEMBER 3, 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 CLOSE IN PORCH,INSTALL NEW ELECTRICAL SERVICE AND RENOVATE INTERIOR & EXTERIOR OF HOUSE. The certificate is issued to JOHN OSGOOD (owner, xxxxxxxxxxxxxxxx) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING SLIP 11/4/88 PLUMBERS CERTIFICATION DATED N/A ~/[~/ _ Building Inspector Rev. 1/81 =-~ FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERM17 MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_ X17585 Date .~ ........................................ 19.~!~. Permission is hereby granted to: ...... ~.a.n.w..R.~er.......... ct premises located of .... ........................................ Cvunh~ Tox Map No. 1 pursuant to application Building Inspector. Fee $..... ~~.:.~. ............ .:Y.lt..... `S..T.:. ..T..T..\............................ .... . ... 3°.. °. . .. .. .. .. ~.. : ~... . l a..~:.........~~;~....~~........~'.~./.~ ................. ........................................................................................................................ 000 Section .....a ~.......... Block ........1........... Lot No....;5l ............. doted ............3~ ........................ 19...Q.'`'and approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~~ to the Building Inspec- torwith the following; 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 water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 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. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pettinent informa- tion required to prepare a certificate. C. Fees: Additions $25. 1. Certificate of occupancy New Dwelling $25. 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $ 5.00 , 4. Vacant Land C.O. $ 20.00 5.Undated C.O. $ 50.00 00 POOLS $25.00 ALTERATION $25.00 Q0, Accessory $10.00 Business $50.00 $100.00 over 5 years $10.00 Date .......................... NewConstruction„/ Old or Pre-existing Building Vacant Land Location of Property . '3~0 /~"Cilc, p"~~/FJ j" e= /~........... ~ l~fhzia ~ ...... . ... .. . .... ....................................... House No. Sheet Ham/et Owner or Owners of Property , ~T~'/~'LJ ~~' ~~ .................................................... County Tax Map No. 1000 Section ..v~."=, ~, , , , , , , , Bfock .... ~. 5 ......... Lot ................ Subdivision .................................Filed Map No. ..........Lot No. /............. Permit No. / ~ ~`S~ Date of Permit ~ ~.( jls';S', .Applicant ......................... . Health Dept. Approval ... . . . ................. .Labor Dept. Approval ....................... . Underwriters Approval ....................... .Planning Board A PProval ...................... Request for Temporary Certificate ................ . Fee Submitted $ ................... . .Final Certificate ....................... Construction on above described building and pe~rmit~Jmeets all~ap/plicable codes and regulations. Applicant ...`.l•.r:'/~'C...46C-.~~`~~, .............. Rev. 70-10-70 ~~c .~' (/ ~ </ /~~ S~,ydr : rcL~7 M1i.J.~..L.+U:i ~~UniY. ~ i;OtYMENT° ~ 7. ~a~ ~~ __ H j ?OUIJDATION -... (1st ) _ __ .- c FOUNDATION (2nd) ~ m 2. .. z 0 ROUGH FRAME & ~a PLUMBI _ NG H 3, a c~-~ IIJSULATIOPI PER N. Y. .. '~ STATE ENERGY CODE (~ ~/l H FI;JAL ADDITIONAL COMMENTS: ~ ~ ' • _~ c~ x~-` ~v H A ~~ y 4 ~ i 0 m ~ \ ' ~\ H ~` . d m H o r -a ~~o ~ ~° d~ ~~ o~ N ~ C1 ~ o N m O ~L n A r `~ u 0 QoS~FFOLI~~` q~, VICTOR LESSARD ~ ~ EXECUTIVE ADMINISTRATOR `y • (516) 765-1802 O~Ol >~ Y`~~~' OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD October 31, 1988 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Carol Bietscher, Atty 6 Saint John Ave. Hicksville, N.Y. 11801 Re: Mr. John Osgood - Pre CO inspection conducted on 10J19/1988 Dear Ms. Bietscher: The house was renovated after 1957 and no permits were taken out by Mr. Osgood to cover the work that was done. He stated to me in conversation at the time of my inspection that it was approximately ten years ago that the work was done. At that time permits were required for the renovation and alteration. He can take out a permit to cover all the following work: 1. Closing in the porch. 2. Installing a wood stove. 3. Electric service and renovating the interior of the house. I will make an inspection after the permit is issued and then hopefully issue a CO for the work on the permit and also a PRE-CO. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. ~~ ~~ Gary Fish, Building Inspector GF:gar -//-->>-~--pp `- L`~aJ` 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ~INAL REMARKS: DATE ~ © D INSPECTOR ~~'~i ..- r• THE NEW YORK BOARD OF FIRE UNDERWRITERS ''~"~' ' eoosz7.~ BUREAU OF ELECRRICIT' JOHN STREET NEW YORK NEVY 1 fi!K 1D 039 ~~• ~ ~ ~~ ~ .:" , ,. 7 (~ ~ ~ P7t>AT}:M iSL;J{ pV,1~~k y OCtb i'7"t SS RR ~~II NN RR 88 Dote Application No. on file THIS CERTIFIES THAT only the eleetrtcal equipment a dascrihed 6ebro and tntroduced by tha applicant ttamed on the Dhow applicetton numher in the premises of JOf{Ft OSC:(X}D, 300 RO('KY POINT ki}., k;A.ST M~ARI:ON, N.Y. in thefollominR loc~~.M~B~m~~~ ~ Ist Fl. ^ Ynd Fl. Section Bfork Lot twaexamined on ondfound to 6e in compliance Tcith the requirements of thts Duard. NItTOIR FIXTURRf ttANORf WORRIO DRCRS OVfSVS DTSN WAli~ RXNAOST FANS QIIT{R}S ACIRS SWITCMB NGNDESClNT nUGlllSClNT AMi. K. W. AMT. K. W. AMi. K.W. AMT. K. W. AMT. N. P. DRT'NS FORNAC! MOTORS MlTINi AMIIANCR INRMS SFRCIAI MC'FT TMY ClOCKB pLL OMIT IMATRRf MOIL ~illT DNAMRRf AMT. K. W. ql n P. GAS N. P. AMT. NO. A W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. n P. ~• ~ FAT AMT. WATTS SHVK! YISCONWCT NO.OF S E R V 1 C E AMT. AMP. TYPE ~ c~ i x tW 1 x SW 7 / SW S X /w ~• ~RCACOND. aF CC C ~ NG. OF HI.IFG Of ~w~lM NO. p mursAla Oi ~~~ ~l OTINR AAARATOS: *WO V75U.A1~ Dl?F'Xt"Y':: "An ~iarTrj^,-i1 eoT•vey hoe bawn m2de of rF?p Pxnne?d elArtrical PQ!1'.F1R9nt in thn ~YP.M7.AE8 lild7 CA t9[7.° n,f(C! Ql'}i•'l Ol!4 Il[?R 3t i, q'Fp CTrirV 1^.~1}ra't Tl!ltl Walq j{vtl T?!~. .[~~ ~ 3(10 ROCKY 4'()~4N'R' kl~l. - A•U.BOX 1.47. MAIpYOB Y:AS?' NARION. NV. 71rd74 t~u j Pet_ ' This wrKlicah mull not 6a ohand in any manner; rNurn h tM office of tlh Board if irtcorrM. hsspectors.FtFaybe idantifisd-by~lMir crr~'infials. COPY FOR WILDING DEPARTMDIT: THIS COPY OF CERTIFICATE AMJST NQT !E ALTERED IN ANY MAlMFR. s. +b5 ei ~?. ti ~< F~ ? 4 t ) 5 SSA Y~E~~f f s p} > x 1 5s~~ ~ 1. % ~} ~ pit psi C p pt" , ~f.t `, x {r jY~f~~~ t~ Y 63~ y~y ....,.,. `°r i ( p t 3 ~ r 3 f`~: 'E ~ p s (S ~~ ~ s , ~ r v~~~ yb ~ x t'Y i a s ~n Z t . '_ [ .a g ,f ~~., r~ r i ~ L ~a,Y< x" ti s ) A ~~ v i 1 ~` ~ `' 3 v A~Yi~~:- ~ it i' x Y ~ a r p~~ r ~ Y t t W 'h'~- ) Y r I d a • it r s~ r %'~t ~ ~~~.~ _ "7"' S ~Mr...,,s C~ ~ ~s1 Sa}~~ ''~,t -- \\f ~fwi.'. {~ L .r..e,., .~7.~;.~ ~`~ r.~,~ ~r.,v."G~i~xtt6y3t ~~ .. .3' :.x.U ., r$. ~ru.5:; ,'6!,^ • -, . „ '~n'~ ,..~, ire...... t'~ ~ ,.., ~ , :} ~'~,_ '~ I n. 'i( ~ei ~f~' w~, e1~ S ~°~~~~ / G5 ^~~3 ~a ~rL" 4 x r Y~- ~^ t {{~ r I' .F'~~~~~~ .-~ s ° ."' ~, .i, l~' +,~``1 .`~ t,3'~~ ~£Pd} t~~'X*ti~'4. b s t p ''{ Py~F~~ 1 ?ahs x j Y~~ ~Wtet~K+i X ~3 S ~ t?~ r 'Y~ } Tu~ ~ e\ry ~+~4+s7 °-"" ' 3~d i~F t 6 ~ r d~u ( Y^r ~ i YY~ t r.3~=l ~e~ ~~« Y~ik.~~.$3, rf{ t v 111 ' ` 4~ ilv~'~S~ly ,~+ }y t! ~.p; _ µi~FR$P`. ~~..4~.f ~/ y~~(~ 4. G. ~ F ... Y~ ~" 1 ~. Vet lGtYnn lb~ rl V1'<~ 4 ~ .•~S r r k ~ ftij> S'.lt4 f.`j~,y~3YV+~"y~''~e ~ Lnd t r Y ~ 4~ ~/ ~~~, ~~ i ~ F ~ rY ~ .S~5ry1f *3t FP~Ya ~f j( ~('~ . E ht, p i OD '~t i °t ~ [ ~y 6p j.wx s ~jYft~~'. a ~ t r ', l e ~( vAt r ~ f t ~ 4. n ( t i• f p ~ 1 i ( t r t ~ a .Ltd ~ ~ rr~ t h ' ~ ".q~ '~~ ei it ~,"li. , e ."; Y~ ~ ~ ~~ p '~ :~ r y i'rfli iy~ iAp~ r.£~h> ~ ..~ ~ 1 J ' { f k ( t ~ }1 gpd Iy {Y~y ~[/~~ r E» Y 1~/~ )~ ~ r ~~"1! y' Y .4 ~A ip ! d' ~ F. -. t f ~~ ~! A X W? ~ jS(" (~l. 4 t3~^t-. ( Ya ~~ 44~+~h. aA 1 x`~'_~.ab ~ § s _7 Y v '..t i., i ~ 1 t _ ~, t ,, }..~ i ~N y ly r. t t ' 0.' ,~ } i. 4m -d iPa sn z 1^~ •~~A7 6 x y ^~~'ti ~ ~ ~ `,~~ ' Y4r e* ..( y.. . ~. _ ., v i ~ e ~,~ ~~ r s '.p axt ka t w y r s F 5 i ~ 4~~ f t F n \T to t `¢~'r~x. , per. ~ ~~.y~ ~~1 ~w ~ ~1'~ e p a ~ a (" ~ ~' C i ~ 1~ S ~h v) ,- s t , r~rrT r y,,,_ L ~', ^tr.~ e r 1 x 1 x ~'L Ee .r " v '4: i ,~~1 ~. '~" l ,~ "a p~ x wr AeP ~k•.~~. •r - ."~i O~ ~ ~C^ t ~ ~ .. ~~.. ~ 4 i t~ ti ~r 5N ttt~". /d ~ ":. s^ ~ '~ 3! l i a'd ~t`.k' ~~3 S ~1:~6rd°a~r" at~,m ~t 'y~~ , fis .~~y ~,ifl''~T4£~ ~ ,~ i R t f "' f e t ~ ~' ,~ { { , t r• r ~ y 5 ?w4 pet e 4 ; pr #'!x*(~, '~~~ ~ Y'^rolY~~`'~f~$#'"7`'' aid dYh7" S..y `SJ°~>F ~ S~ ~ p r 1 k" 's" m ': ~.t 4 f '' Y ''2iYi ~f'i„ ~' t'^f'E: r'Y ~,y~~ '~,~~~' i ~V' b' , ., k~PTkeC w .~ a~~~ ", { r 1 r ~ ' ~ ~ I ^ v~? F x 1 4pi,,.+ t ~ r, ~~ ,F~Y t ~ & ~ n 4 alit v ~ C"~ ~ k .. ~t~ p .. p 9 Y ,t t s rJir2.,. "p~)y a i 9 p ~ _ A A t ~~ 31 Y t ~C t.. ~ K i ( '/ 1 L t A J 'A ~ 4}F J 3 Y~Ft }61(b ) \iM1 ~ ~~ t,i ..."~ 14.rN 4~.AY. ~ ~ _ t L l: d 1 e M y~l .}L yet „J~ ~ u '~ t . p Y ~ I ~ ~ ~ t \ ~ + ~ 1 ~ ~ ~~ 3 ~SS Ct~4~ t ~-r ~~ ~' ~ ~~ x,>, V" A z ~ ' .. O O ~LF1'~i ~ ` rd r rf ' g ~~L °~ A ~ ~ ~ y E'~D~}_t ^- ~-1 (an q ~ z :.c A ..'i 4t.~r. _~ ..,._._St 6i i _ gyp. t i i ~ ~ ! r A xr -~ t t }^ s aH f C , ~ t ~ r a', rY~~YIS./)t A~, l ~h'1.~~ _ dr A )S s+2"', yS, to r ~ t 1' t (. „, ~~~. ~.-` I~+~C%, t~l~w1~t~~~lC~.;a "('u"i. ~;i% fit': "4"ji,l%l"`r' !ih1.."~"rC?~,'r. ' t m; ~~ A y ~.~ ~+1 Y ( ~ ~ ~F r ;'~ t .. :i ( ~p t ! i ,. _ e a 'f ~ rt ~ ^ L ~. v.r 5 ~. ~ .yr~y ~' y ~ .. _ r ~ i f i t C`~~ ~~ 1+.'fl' ~ `k ~,.It+ f/'t _ ( ~ r 31 ~ d # r f ~ i t ~4 ^"t SFr) fit pf `fir v' + ..yt +ej,, ~ ~a~ ~ d ~ <A -~ ~ y}a ! a ~'sXVi' 1d '~4( \/ L ~ M1.'~V'11~~.'~~~;.tL~~ i 'Y 1~ ~ L ~~ ^YYS (3Yi t~ t ~l .. ( } L y r > 1 r x ! ^,.~ T' t } .% ~, v t t 1~ t s t w a p, p rA . S t _ s( 1j .1 ~. 4^Y'l ~. t`l r I ~`` ~ 1 qq r f _ (A ? N ~5 t }``i'a {'.t iZ.. S\~ l,l ~y t ~ d s~ r ~ ° fi ~~ '~ ~ 1 r i f A ~ ar 'r t k~sa. 1 ~ +k . r ' J r a 'S3 t t s ~ £ r t i; r S~t~4\ S y > dY~ } .YA rr~ Y~G 1 ..+........w.,.n..4w.~....: ~`t `f. "'\ rY">~~,..r.r+w...a.,.~siste..u: .wv a.,C.~....n..f ..,,...w...~S...... .~. r ~ z~ 4'1 ~r* t ny~ SY"a' v FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. 11971 - TEL.: 765-1802 Examined ... !l Pf! •..2:~ ...., 19 App.~ Approved ... l'~Y'•.:-?, , , , „ 19O~Permit No.. S~I.J~~ Disapproved a/c ..................................... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL T0: ....................................... ...... ( it ing Inspector) APPLICATION FOR BUILDING PERMIT 0~' 31 Date .......... . ........ 19 INSTRUCTIONS 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 a_ppplicable Laws, Ordinances or Regulations, for the construction of buIldings, additions or alterations, or fo 6~~'$'1~1~t~ion, as herein described. ', The applicant agrees to comply with all applicable laws, ordinances, building cod ~c~tsing code, andTaegulations, and to admit authorized inspectors on premises and in building for necessary in .. '~ s.r3~::~...-. ( ~t~11~ ~''~,~If a-'corporauonj.. . ~ R Ys ta_a-: ( .... x~l~ai~,IN 3.g ; . ~I+14~A~i.M1 ~ #FfI~AA3Ft - Sl~Iiltr.7 °~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, ell~{~p'Iaidh?ptuihber or builder. ',1 ~--/~ 7Affitl~lA 8Y46~"S ~ .IaFtIR. ;, Name of owner of premises ...~~.1!Y11 ..~ :.. ~S,~B2~.~ ..yam , .I:t~R. ~tiz , , ....... , . . (as on the to lads ~1r~Y'~'. If applicant is a corporation, signature of duly authorized officer. ''B"1k``~ '~ tsa3 t~ ~?:;~'t~^ .............................................. (Name and title of corporate officer) Builder's License No. ..S~L~~ .............. . Plumber's License No. . ~~~.L, -~ . .............. . Electrician's License No. .'~.'-C.b.. <~{7./~I~~~' Other Trade's License No. ..~ ................. . 1. Location of land on which proposed work will be done . ............... ~. ................................. House Number Street Hamlet ,.---° County Tax Map No. 1000 Section ..~.. f ............. Block .. f............... Lat .. F? Subdivision ...... ~..~ ........................... Filed Map No. ...~........... Lot .. ~'.......... . (Name) 2. Slate existing use and occupancy of premises an~~d,ittntended use and occupancy of proposed Construction: a. Existing use and occupancy ... ~~2./. ~e•av~~• • • • • • • • .. . .... ~ ~ VlAlei t Ina &~ir # YFSatRfi b. Intended use and occupancy ""'`°'` ~ ~~ '`~ ............................. .................................. f i r , ...., „ ~ r 3. Napure of work (check while Applicable): New Building .....'..... Addition .......... Alteration Re air moval .............. Demolition ... , .......... Other \Vork ... , ..~~ ~ ~ . ~S~ (Description) 4. Estimated Cost ... ~1!!.d'.UU ......................... Fee , .................................... . 5. If dwellin, number of dwellin, (to be paid on filing this application) 5 ,S-units • • • • • • f • ....... Number of dwellin units on each floor . ,~-,Qd If garage, number of cars ~-'.."~........ S ~' ' '~ ' ' '/~'' 6. If business, commercial or mixjed occupancy, specify nature and extent of each type of use .................... . 7. Dimensions of ex(Sting structures, if any: Front .. , . , , , , , ,Rear Depth . Heig}~t , .; S ,:,:;;~;i ~:~. ' .. Number of Stories .................. .......... , ... ............. . Diirien'siorisbf'sa ..~ ............... , ... . ~~~ tt~~ture 'with alteration or additions: Front Z De th .. .. gh .~.o~~k...../.~~ .. ~..~......... Rea :....~ ... , ...... . p ~ old . Ilei t . , Number of Stories . $. Dimeps~o~s a ntir a ew construction: Front ...S(~.~, , , . Rear .. S.f1)'la,E. , , , , ,Depth , ~/,~'y(~t,rt, , Height . ,~ ~,(%';;, it, Nu(nber of Stories ... ~-/~~Y1.~; , ' ' ' ' ' ~ ~tft€t~t~3t~~, ~~~,K... (. ~G~.~.. Rear .................... . ... e. [h ...................... . ..-x••..-.«,. '"""rv. ~'f ................... Name of Former Owner ~..p.~ ~.~7~,~:/; ~-:-:........ . TT:"'tone P r pse district in which remises are situated .. , ~,~5(,'p~Y, j~;L. ; , , , • . , P 12. Does ro osed construction vi late any zoning law, ordinance or regulation: ,, \\ • .N'~ ........................... 13. Will lot be re raded $ 14. Na ne of OArchiteoi remtsas~ ' ' ' ' ' ' ' ' ' W~p excess fill be removed fro ~emises: Ye p ~ ~ . ~. ~'.. D.SG~"D.I?. Address3PF? ~~: ~.~~~?r ..done No. ~7..~~.1.1.~ • S~(r~. • • • • • • • ........Address . .Phone No, . Name of Contractor . 5,( ~F. , ,Address . .Phone No. . 15.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 all 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. DATE: 796-1807 S AM 1C! 4'MYt~FOR THE FOLWWING INSrECT10NA: 1. FOUNDATION 111`1p p FoR nol~glD 7. ROUQH • N~'LLIMMNO B.INSUlATION ', 4. FINAL - CONS NAT BE COAAq.E1! FOIL Q AI.L CONB'ffplC'{1p11 THE REOINII 1iEt~ STATE CON~{N1~ ~ rIMIgY CODE'. Nfy- IEi~1114f1/~Lf /~ DESIGN 011 CONdTIN1Or!1011 rMlDllt STATE OF NEW YOR~, COUNTY OF . S'cr•P• .04/x.... , S.S (Name of individual si~n~ • ~ ~ ~ ~ • • ~ • ~ ~ ' ' ' ' ' • • • • being duly sworn, deposes and says that he is the applicant o ang contract) above named. i He is the ..................... ...... I (Contractor, agent, corporate officer, etc.) ~ ~ ~ • • of said owner or owners, and is dul' authorized to perform or have performed the said work and to make and file this application; that all statements cont~ined in this application are true to the best of ]tis knowledge and belief; and that the work will be performed in the mannef set forth in the application filed therewith. Sworn to before me this ct ...... a'~ ........ . ......day of',, Dc~-p.,~ e H........., 19 ~~. Notary Public, • ' ' ~ . •M:a~A-~~yANN~/BO •~• . • • . ~ • • • ' ' County //~~ ,p / /~ PoV /~L,1,141AN~ GC~J!/K`~i;/J?J-T/•-• . . ..... Notary Public State of NewVYllk ' ' ' ' ' ' ' ' ' ' "'' ~1'?258 (Signature of applicant) ~ ~ ..,~k County C.'., ~ ~~,.~.~~_, ,,,..,., rc•3J'uary29, fB~