HomeMy WebLinkAbout23573-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26714 Date: 09/29/99
THIS CERTIFIES that the building HOT WATER HEATER
Location of Property: 305 SALTAIRE WAY MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 100 Block 1 Lot 16
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 12, 1996 pursuant to which
Building Permit No. 23573-Z dated JULY 12, 1996
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 HOT WATER HEATER INSTALLED IN AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR AND WITH NEW YORK STATE VARIANCE.
The certificate is issued to CHARLES & ANNE MCCARTHY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 11658 07/10/96
PLUMBERS CERTIFICATION DATED 04/16/96 LAWRENCE TRAPASSO
d"J'— *A'A
Building Inspec r
Rev. 1/81
!'OHM NO, f
TOWN OF SOUTHOLD
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° 23573 Z Date .............. ... .. AT.''. ................., 19
Permission is hereby pram to: ,'�, '�`
..°..f/ll zz(o./69r.4�r...... .
............................
`1....1..1..7'/y
to ...........
....
at premises orated at .............. a ...., .. . .. .
..................................................... Vv ,e!!- r...................................................................
............................................................................................................................................/.........I.............
County Tax Map No. 1000 Section .....A ...... Block ......../.......... Lot No. A.. .P..............
pursuant to application dated ............... ......... 19.1<., and approved by the
Building Inspector.
dw
Fee i..7
.. �. . ........
... . . . ..... ..... ..
Building Inspector
Rev. 6/30/80
Form No. fl
• + . • TOWN OF SOU111OLD 45 M�
hUILO1P:G UBPAI:'rULlrrt -�,,,V' rq ,
TMIN HALL F.
765-1802 Son�tVt1
nPrLlc,rrlDN FOR ceRrfrlcnra or occupno: w
A. This application must be filled in by typewriter OR ink and submitted LU��CY building
inspector with the following: for new building 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 from 1lehlth Dept. of water supply and sewerage-disposal(S-9 form) .
3. Approval of ulectriawl installation from Board of Dire Underwriters.
4. Sworn statement from'plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installatioas,la certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board 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.
C. Fees _
1 . Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $20.00
4, Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential. $15.00, Commercial $15.00
Dare �_ t& ct �
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Oil r Pre-existing Building. . . . . . . . . . . . . . . . .
Location of Property. . . .3��.�. . .r. ,+-4Q.�Jf. (.etc.-L{. . - . . . . . [4'.}' ; ."fi;tc.! -. . . . . . . . . . . . . . . . .. . . . . . .
(louse No. rl Street hamlet
Onwer or Owners of Property. . L+k)nK hSoo. . . .cc4 ! �� � .j�: . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. .j�I!yy1 . . . . . .Block. . . . . . . . . . . . . . .Let. . . .1(0 . . . . . . . . . . . . . . .
. Subdivision. . ..^�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Mop. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . ,JDate Of Permit. .��'2-0.". !_�'q . . .Applicant.Z.E�it4Clot , o+(, A5001--1
Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
lequcst for: Temporary Certificate. . . . . . . . . . , Final Certicate. . . . . . . . . . .
°ce Submitted: $. , ,CAS-D6
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4p i
i
STATE OF NEW YORK
DEPARTMENT OF STATE
ALEXANDER F. TREADWELL ALBANY, NY 1 223 1-0001
SECRETARY OF STATE
In the Matter of the Petition of: DECISION
Petro Oil
For a Variance to the New York State PETITION NO. 1998-0778
Uniform Fire Prevention & Building Code
Upon the application of Petro Oil, filed pursuant to 19 NYCRR 450 on August 27,1998, and upon all other
papers in this matter, the Department makes the following determination:
NATURE OF GRIEVANCE AND RELIEF SOUGHT
The petition pertains to the replacement of a water heater in a building of Al occupancy, two stories in height ,
of type 5 (wood frame)construction, approximately 2,500 square feet in area, located at 305 Saltaire Way,
Mattituck, Town of Southold, County of Suffolk, State of New York.
The petitioner is seeking relief from:
9 NYCRR 717.3(e)(4), which requires that floor-mounted fuel-burning heat-producing equipment within a
garage located below grade, or within a below-grade space opening directly into a garage, shall be installed on
a noncombustible platform not less than 18 inches above the floor. [rhe petitioner requests relief to allow a
new oil fired water heater to replace the existing water heater to be installed on the slab of a cellar that opens
to a garage located on grade.]
FINDINGS OF FACT
1. The oil fired water heater has been installed on the slab in the cellar below grade.
2. The cellar is accessible to the garage through a self closing fire rated door and up a set of poured concrete
stairs.
3. There is a raised approximate 12 inch high masonry barrier around the stairwell opening in the garage. The
barrier lowers to approximately 8 inches at the top step. This barrier will effectively prevent any fuel spillage
from traveling down the stairs to the cellar.
4. The slab in the on grade garage is pitched towards the garage doors to the exterior.
5. The water heater in question is located approximately 40 feet from the aforementioned door at the bottom of
the stairs. 0 printed on recycled paper
r i
1 Petition No. 1998-0778
Page 2
6. The petitioner has agreed to install a smoke and fire detecting device in the cellar which will be interconnected
with devices on the upper floors.
7. The local building inspector has been consulted in this matter and does not object to the granting of a routine
variance under the provisions of 19 NYCRR 450.6
CONCLUSIONS OF LAW
Strict compliance with the provisions of the Uniform Fire Prevention and Building Code would produce a
negligible additional health, safety and security benefit to the occupants of the building.
DETERMINATION
WHEREFORE IT IS DETERMINED that the application for a variance from 9 NYCRR 717.3(e)(4), to permit a
new oil fired water heater to replace the existing water heater to be installed on the slab of a cellar that opens to a
garage located on grade, be and is hereby PROPOSED TO BE GRANTED with the following conditions:
1. That a smoke and fire detecting device be installed in the cellar and be interconnected with devices on the
upper floors.
This DECISION is issued under 19 NYCRR 450.6. Unless objected to by the petitioner in a writina received by
the Department. the decision shall become FINAL after fifteen days of receipt of the decision by the parties.
This decision is limited to the specific building and application before it, as contained within the petition, and
should not be interpreted to give implied approval of any general plans or specifications presented in support of this
application.
George E. Clark, Jr. '\
Director, Codes Division
DATE:11;7 `i
RAS:siZ
Rumre 2' t.P" �a
R 'head,N1' I I�01 R""hrad tia;r lLcr
I S M"22.81'+
r'as:0161-2Lsr--
Rrg A Office P ET R O
a8 Harbor Park Darr
Pm Waeh+ng¢m,NT 11350
18007 06,HEAT
Heating Services a.
e
4
r,
i
I October 30, 1998
Town Clerk
Town of Southold
Town Hall
53095 Main Road
Southold,NY 11971
Dear Ms.Neville
Petro Inc . of Riverhead is pleased to submit
the following bid on All Gasoline for the
calender year 1999. The price will be plus.0649
per gallon over the Tosco Refining Co. Tank
Car Consumer Rack Price.
Sincerely,
,W1)
A.H.Westerlund
Plant Manager
ELIZABETH A. NEVILLE tiy' fes'. Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
y Y Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %r
MARRIAGE OFFICER O Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER y?J�l Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER .'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
October 8, 1999
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Reliance Associates
P.O. Box 1457
Stamford, CT 06904
Dear Sirs:
Your check No. 0019114026 in the amount of $25.00 issued to the Town of
Southold for a Building Department Certificate of Occupancy was returned by
the bank due to a stale date. The check is dated 4/19/96 but not was
submitted by the Building Department to the Town Clerk's Office for deposit
until September 29, 1999. Please resubmit a new check in the amount of
$25.00 as soon as possible. Enclosed is a self-address envelope for your
convenience.
Thank you for your anticipated cooperation.
Very truly yours,
�Q /
�
Elizabevile
Southold Town Clerk
Enclosure
/: Building Dept.
* FOR DEPOSITED ITEMS RETURNED
THE FOLLOWING CHECKS HAVE BEEN RETURNED
. .REASON. . . . . . . AMOUNT
PAYOR. . . . . . - . 2S . 00
VVT.TANC-'F, ASSOCIATES STALE DATE
RELIANCE ASSOCIATES Chemic.l8..k(oeLw.) 7,anrs.:;
P.O. Box 1457
1201 Market St.wil fi ",DB 19801
tamtaXd, ,CT 06904 04 19 9610012114026
1822 :b➢ � -.. +'z xHt� UN2' I
6+-26 25 .00
6 311
a3t"`
. .PAY THE l:fP,ygi.r., 03G' 79203 -
sum OF; Twenty-Five and 00/100 Doll S �"-'%."iw''3. ` _ ^
TO THEY
i..ORDER OF TOWN OF SOUdi� �:.w-, t. J *y \ •6\ !` ` \ i
fry
b Epe Et1 M MW.
11'0019LL4026i1' 1:031LOO 26 ?: ' L8221350'91i'
0024 _. s.t�ii L�,3 Ottl fc ac]clf3ol 500",
Petition No: 1998-0778
The persons below are advised to TAKE NOTICE of the attached document. The attached
document pertains to a petition for relief related to code requirements. If there are any questions,
call (518)474-4073 and ask for the Variance Unit. Please refer to the petition number in all
related conversations or correspondence with us.
PETRO OIL
44 HARBOR PARK DR.
PORT WASHINGTON NY 11050
GARY FISH
TOWN OF SOUTHOLD BLDG DEPT
TOWN HALL MAIN RD.
BOX 1179
SOUTHOLD NY 11971
CHARLES MCCARTHY
305 SALTAIR WAY
MATTITUCK NY 11952
0
d
11. 1lil.lf MSPEc•rtoN Rr:eoR•r nn'rE coMMl:Nrs G
l
FOUNDATION ( IST) II
II
II
FOUNDATION (2ND)
ROUGH FRAME. &
PLUMEING
II �
ii
II I y
----
INSULATION PER N. Y.
STATE ENERGY II
CODE �C/
.,'�7�
�I - --- �i--` - - -'---- - 1' �'. =-6K?'iGfa-��. sL ��G�►�.
II
10
Y f NAI.
It
ADDiTIONAI. COMMENTS:
- -- - ----------
-----------
---- - -------- --- - --- - ---- ---- ' - ------- - -- t:
Town Hall, 53095 Main Road rz o Fax (516) 765-1823
P. O. Box 11793 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR J, 0 1996
TOWN OF SOUTHOLD
L-7 Q01v11v1'0F SOL)I-h
C E R T I F I C A T 1 0 N
DATE: A4— iu-ci(a
Building Permit No.
Owner: 0,hiqlel-t-S MC& rlht, -h
(please print) y
Plumber: Lawrt, vjo-e -T—Y-1eLt:sso
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(Plumbers
Sworn to before me this
day of 19
Notary Public, Lj County
'T"I
FRACCAof NLVIERowI...
110tov
mw suns
No.624852599
Commission
County
Com March 30,Y9-4
`pElem t a a35 "73 z
OIL BURNER
Certificate of Inspection
D App.#: 11658
Name_(--harac Mrl`arth Tr
Location: -j(15Sal tairp Wly, Mattiturk _ Naw Ynrk
Applicant: Reliance Fuml Oi 1 ASEQQ ataS
Address: 77 South Street , Patrhnmia New York
Tel.Na 475-4754 IJc.Nc, 2901RE Expires:
ELECTRICAL. INSPECTION SERVICE, INC.
375 BUNTON AVENUE
EAST PATCHOGUE,NEIN YORK 11772
2
2/� Q./...4.6................TEL: 516 28666 .C]ft 0•
7 -3
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUG LBG.
[ ] FOUNDATION 2ND [ ] 1 LATION
[ ] FRAMING FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS
i
DATeI2 INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH FLOG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
L
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSUL/1TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: _�A-/ ,_���� ,
DATE INSPECTOR ../L
! (5 R f2 BOARD OF HEALTH1
1�
FORM NO. 1 J SETS OF PL .lS . . . . . . .
TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . .
�+ � BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . .
TOWN HALL SEPTIC FOR:1 . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TOW „.� i TEL.: 765.1802 r:a<1Ft ;
CALL . . . . . . . . . . . . . . . .
Examined . . . . . . . . .!.�, 19 11A 11, TO :
. . . . . . . . . . . . . . . . .
Approved , I��OPermit Nq�/j . . . . . . .
Disapproved c . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Building Inspector)
AP ICATION FOR BUILDING PERMIT
Date . . : .r. -.1 . . . . . . .. 10
INSTRUCTIONS
a. This 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 stree
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app
ation.
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 perm
call 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 Occupanc
tall have been granted by the Building Inspector.
APPL .�;O N IS.HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th
uilding orib ordinance oL thg Town of Southold, Suffolk County, New York, and other applicable Laws,Ordinances._
egulations, for'•'tite-cotlstruction of buildings, additions or alterations, or for removal or demolition, as herein describe,
lie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t
trait authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
-7 -1 Sy;-t-Mi sfi . PA-r�h4�.�. Ny. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Mailing address of applicant) at')71
ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
ori1 c,'.f:QY . .('.'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .
ante of owner of premises . 4!h�r �� Ltl Y- {,e �
(as*o'n'thl tax roll or latest deed)
applicant is a cbrpofat 6n, signature of duly authorized officer.
. . . . . ... . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .
(Name and title of corporate officer)
Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . .
Plumber's License No. V0
. . . . . . . . . . . . . . . .
Electrician's License No. . . . .`, G
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. `7. . . . . . . . . ��?, 1 �� .I- v . . !j�c� I Kh: 1 �+� . . . . . . . . . . . . ... . . . . . . . . . . . . . .
[louse Number Street Hamlet
County Tax Map No. 1000 Section . . ,10430 Black . . . . . . . . . . . . . . : . . . Lot . . . 1.
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 . . . . . . . .�. . f' t ` 1J.+!?e.��.�,(lo . . . . . . . .
,
b. Intended use and occupancy . . . . . . . . . .1. �•� •'. S �. . . . . u. FifQ Ir . . . . . . . . . . . . . . . . . .
-3. Nature of work (check which applicable):New Building
Repair . . . . . . . . . . . . . . Removal . • • Addition . . Alteratior. "'•
• • • • • • • . Demolition . . . . . . . . . . . . . . Other Work . , , , , ,.
4. Estimated Cost . . . . . $. I a q •vp (Description)
. . . . . . . . . . . . . Fee . . . . . '$ . �'� .d U. . . . . . . . . . . . . . . . . .
S. If dwelling, number of dwelling units . . (to be paid on filing this application)
If garage, number of cars ' • ' • • • • - . Number of dwelling units on each floor . . . . . . . . . . . . . .
• • • • • . • • . • . . . .
6. If business, commercial or mixed occupancy,
7. Dimensions of existing structlures,if an specify nature and extent of•each type of use . . . . . . . . . .
Y: Front . . . . . . . . . Rear
Height . . . . . . . . . . . . . . . . . . . . . .
Number of Stories . . . . . . . . . . . Depth . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front
Depth . . . . .. ... . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . .
8. Dimensions of entire new construction: Front ; • . Number of Stories . . . . . . . . . . .
Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . .Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . .
9.
Size of lot: Front . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Date of Purchase . . . . . . . ' • • • . • • • • • • • • Depth
11. Zone or use district in which premises are situated , Name of Former Owner
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded . . . . . . . . . . . .
14. Name of Owner of ha-r Ie ' ' . Will excess fill be removed fromp,premises: Yes .
premises . . . . . -' .—f rT JrAddress 34$.-3 Nair N'r_
Name of Architect e •'�`•`�hon`eKIVo. .aZrt
Name of Contractor f ye( � ' ' Address . . . . . Phone No. . .
.Ol 4 Address . .'P',`?"�?-�G c) �v Phone No.4:.i ;�;7;�
S. Is this property within 300 feet of a tidal wetland? � Q• • . . '
*If yes, Southold Town Trustees Permit may be required. . . ... . No. " "
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions frorr.
)roperty lines. Give street and block number or description according to deed, and show street names and indicate wh the
nterior or corner lot.
� o
If•copper tubing is used Is UNLAVf"i,,1F2.
for water distributing
system; piping Shall be IL
'i 0,
Y 9
� � APP OV AS NOTED
y3
of esK.orLonl � � � � � � �
GATE: B.P.
1%U pp �Fj 0 1&
' vt
FEE: BY.
® NOTIF BUILDING DE
765-1802 9 AM TO 4 FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REOUIRED
FOR POURED CONCRETE
PLUMBING ��VCR2. ROUGH - FRAMING & PLUMBING
ALL PLUMBING WASTE ®� .C'k*l? F 3. INSULATION
&WATER LINES NEED I*'�'��� AD C�&7-j;�;IC47/Q1V 4. FINAL - CONSTRUCTION MUST
TESTING BEFORE COVERING lC,��� ��'lO BE COMPLETE
�' 0,,-,o� Q�� ALL CONSTRUCTION SHALL MEET
04D&9 � �� THE REQUIREMENTS OF THE N.Y.
X19' Cy STATE CONSTRUCTION & ENERGY
� � '�`�`r '�TR CODES. NOT RESPONSIBLE FOR
21,10 o C1Ili " QT. DESIGN OR CONSTRUCTION ERROR$
kTE OF NEW YORK,, „
UNITY OF . . .�.cl ..{-. LIC.. S.S
y�QA . . . . . . . . . . . . . .. . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
ve named.
s the . . . ►'1 YciL Fu✓ -f!� . .'CF.`4-c 1. . :. . . ,� ASSdc
(Cont ractor, agentcorpora. . . . . . . .
te officer,. .etc.) . . . . . . . . . ... ... . . . . . . . . . . . .
,
aid owner or owners, and is duly authorized to perform or have performed the said work and to m
ication; that all statements contained in this application are true to the best of his knowledge and belief;and h this
he
c will be performed in the manner set forth in the application filed therewith.
rn to before me this
f
day of
�. . . . . 'r.I. . . . . .,
try Public, , . • • , , 19
. .
• \ • • . . County
R�•v.n'.iMn•...w..i..�4�n!i'.I,.^.y7'^�.nyyip.�d.AIL'[
VITO E.FRACCAI vu" � . . . . . . . . . .
Notary Public,State of Now ye* (Signature of applicant)
No. 52-4652699
Qualified in Suffolk County "t
Commi�si �e,ims March 30,19
E