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Home My WebLink About27155-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28497 Date: 06/10/02 THIS CERTIFIES that the building ACCESSORY Location of Property: 2355 REEVE AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 100 Block 1 Lot 43 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 13, 2000 pursuant to which Building Permit No. 27155-Z dated MARCH 19, 2001 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 ACCESSORY TENNIS COURT WITH AN 8 FOOT FENCE AS APPLIED FOR. ZBA #4943 DATED 5/03/01. The certificate is issued to NANCY E STROKER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Au iz Sign ure Rev. 1/81 FORM NO. 3 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) PERMIT NO. 27155 Z Date MARCH 19, 2001 Permission is hereby granted to: NANCY E STROKER 166 DUANE STREET NEW YORK,NY 10013 for . ACCESSORY TENNIS COURT 60 ' X 120 ' IN REAR YARD WITH 20 ' MINIMUM SETBACKS AS APPLIED FOR. 1 telq J3 I: at premises located at 2355 REEVE AVE MATTITUCK County Tax Map No. 473889 Section 100 Block 0001 Lot No. 043 pursuant to application dated DECEMBER 13 , 2000 and approved by the Building Inspector. Fee $ 39,.00 Authorized Signature ORIGINAL Rev. 2/19/98 Form No. 6 cq q8 -WPp9� TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL D 765-1802 Dib 1 2 APPLICATION FOR.CERTIFICATE OF OCCUPANCY BLOG. DEPT. 4{ " JQM k. This application must be filled in by typewriter OR ink F S UTHOtD and subm tted 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-9 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 1% 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 Board Approval of completed site plan requirements. 3. 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. 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - .25 ► 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . lew Construction. . . . v.. . . Old Or Pre-existing Building. . . . . . • • • • ,ocation of Property. . 261165Kee,,re- � �0_ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet Inwer or Owners of Property. . . . . . . . . /-/73F1 B5 14.%vv :ounty Tax Map 'No 1000, Section. , ,Block. . . C7�JU/ .Lot. . . . , , d5ra3 , , . . subdivision. . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed 1�,4,ap. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . 'ermit No��I:�i�/. 7t(TDate Of Permit. .'�l:.j �jl.": .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . lealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . 'lanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . tequest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Pee Submitted: $. . p . . . . . . . . . . . . . . . . . . CWCANT APPEALS BOARD MEMBERS O�OSQFFU(�C Southold Town Hall Gerard P. Goehringer, Chairman 53095 Main Road James Dinizio, Jr. y M P.O. Box 1179 Lydia A. Tortora 5 • Southold, New York 11971 Lora S. Collins y'�O a�! ZBA Fax (631) 765-9064 George Horning Jr Telephone (631) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF MAY 3, 2001 Appl. No. 4943— NANCY STROKER. STREET& LOCATION: 50 Harborview Avenue, Mattituck 1000-100-1-43, DATE OF PUBLIC HEARING: May 3, 2001 FINDINGS OF FACT PROPERTY FACTS/DESCRIPTION Applicant's property consists of 80,000+- sq. ft. in area with 187.51 ft. along the north side of Harborview Avenue and 387.26 ft. along the west side of Reeve Avenue in Mattituck. The property is improved with a two-story frame house and garage as shown on the survey prepared by Kenneth F. Abruzzo dated April 14, 1994. BASIS OF APPLICATION: Building Inspector's March 13, 2001 Notice of Disapproval under Article XXIII, Section 100-231 B, which states that fences are not permitted greater than 6-1/2 feet in height when located in or along side and rear yards. AREA VARIANCE RELIEF REQUESTED: Applicant is requesting a fence enclosure at a height of eight (8) feet, when measured from natural grade (ground level) as an enclosure of a 60x120 ft. tennis court structure. The fence enclosure is proposed at a minimum of 20 feet from the side and rear property lines and under the Code requirements must be located in a rear yard. REASONS FOR BOARD ACTION: Based on the testimony and record before the Board and personal inspection, the Board makes the following findings: 1. Grant of the area variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The property is a large, two-acre comer lot with two front yards on Reeve Avenue and Harborview Avenue. The proposed tennis court would be located in the conforming rear yard area, and set back a minimum distance of 20 feet from the adjoining property on the northwest, and 20 feet from the southwest adjoining property line. The variance to increase the fence height by 1-1/2 feet will not have an adverse impact to nearby properties. 2. The benefit sought by applicant cannot be achieved by some method, feasible for appellant to pursue, other than an area variance because and 8 ft. high fence enclosure is considered the minimum height for standard tennis courts and the Code limit is 6-1/2 feet. 3. The requested area variance is not substantial and represents a 1-1/2 ft. increase in the Code's 6-1/2 ft. height limit for fences. 4. The proposed variance will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district. No evidence has been submitted to Page 2 - May 3, 2001 ZBA Appl. No. 4943—Nancy Stroker Parcel 1000-100-1-43 at Mattituck suggest that grant of the fence height variance will have an adverse effect or impact on the on environmental or physical conditions. In considering this application, the Board deems this action to be the minimum necessary and adequate for the applicants to enjoy the benefit of a fence enclosure for a tennis court structure, and that the grant of this variance will preserve the character of the neighborhood, and the health, safety, welfare of the community. BOARD RESOLUTION: On motion by Member Tortora, seconded by Chairman Goehringer, it was RESOLVED, to GRANT the variance as applied for, SUBJECT TO THE CONDITION that lighting shall be shielded to the ground to prevent glare onto nearby properties. VOTE OF THE BOARD: AYES: Members Goehringer (Chairman), Dinizio, Tortora. (Member Homing was absent during the adoption of this Resolution. Member Collins was absent.) This Resolution was duly adopted (3-0). RARD P. GOEHRIN R CHAIRMAN TOWN JUTHOLD PROPERTY RECORD CARD STREET VILLAGE DIST. SUB. LOT h0cinQ E. t4rok-e-r-,, /�ac -)7)4-7vgf 0 #0 4, FORMOR OWNER N E AGR. en /t l 5S W TYPE OF BUILDING f RES. �b SEAS. VL. FARM COMM. LAND IMP. TOTAL DATE REMARKS ( 1 t goo ft-6 7o0 9600 3 9 l 9f, o f C ,t 900 73oo 92,00 c?K2.LY _ . o ?(O G " FRONTAGE ON WATER TILLABLE fr, 0 FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT U TOTAL J f l ■■■■■■■■■■■■■■■■iiia ■■■■■■■iii■MIiiiiii■■ • 01 IMMEMEMEMEMINIMMEMEMIMMIN - ■■■■■■■■■■N■■■■■■■■■ ■■NIM■■■■■■■■■■■■■■■■ ■i■fiiii�iiiiiiil!�L'��!!�■ ■■■I■■■■I■■■Ni■■1■■■■■IES ■■■1!!!!!■iN■■■IMI■iii■IMI ■■iMIQii!■MIi�IM■FIs■■■■■ . "' ■■■■■v■iiimii�r■■■■■ ■NOON■■N■ ■■■■■MINIMI■ ■■■■■ ■ ■ ■NIM■■ ■■■■ ■■■N■■N�IMMNIMENEEMIN■MIM■■■■�■ ■■■■■■■■■■■ FULL ♦ / P , Foundation ® , �® Basement CRAWL SLAB �OYn9 OAV � 6 MAR 14 lip v " \ - , � e �s919 `PC+U yTy e �HOUT CES FI ATE CuprA L ` 5 Pv�G�a \APER V D AS N1 TED DAT ,3 B.p # 27 z7 \ FEE: Y.tz NOTIFY ( pr : ' 'J •-a • ' PA TM NT AT \ 765-1902 M p F THE FOLLOWI PEC 10 2 1 FOUN - TdNd REO ARED FOR P CONC 2- RO RAMIY.3 W1 IBING "`urn \3. U ON D � / N°.4 �\ �e'k La C UCT N AUST I .4C�,(jacc� O,S �cY v.-rrlJ E 0 Y Com �.�� A A S CTI- SH LL MEET �rs.3� °^ T R IREMENT 0 THI N.Y. �aritr ks q•S Gj .' T CONSTRUCTIO EN RGY Y" ^moo. 55 DES. NOT RESPON BLE FOR DESIGN OR CONSTRUCTI ER ORS 4Z« INOTE, 1.CLEOf SUFFOLK MLP FILED IN THE OFFICE OF THE RK FILE Of 0332.FFOLK CQINTT ON MAY S/, ISBB AS [ flLc No az. i !. a•STAKE FOUND SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CERTIFICATION SURVEY FOR: 1 AN r 11 aK SI Faa WP*WAL AYa commucam a PAISLAWAq KNMZ s' ++mmMiQ""�Nu'FMAYM MSAYo.uMKICMy.K011101 s STEPHEN J.TUTHILL d SUSAN C. TUTHILL Kit" arAoa Are a ng rarr m•dxranax:t• LOT NO. 5, "OREGON HEIGHTS" AML mre ealAxAYC App�° At: MA,rTITUCK Town of: SOUTHOLD AS'Slr mnNSa Suffolk County, New York am STAN: a cm: auPHM ARIMSa: Suff. Co. Fox mop: ,1000_ , 100 1 _ L 43 --- S.• ara__ Ln • CERTIFIED To: .t,�Ur yr Young k Young, Land Surveyors STEPH[N J.TUTHIL A,f H F SUSAN C.TUTHILL 400 Ostrander At, nut..JHverhapd, Now York 11801 NORTH FORK BANK ■ 616-07-2905 LAWYERS TITLE IIo N If E 11 11'94 4 Atden W. reury. Projeselonat !n/tluer ! Ban! Survoyor /'""�/"• �• AIE :A N:�0;1 � soward F. r land Surveyor SCALE :1"v SO rhomas C. ►o*"tt jetlonat lnStnaer ,IDB NO. :1 . 6 fanrufh P. ASrvara. Land Survavor JOB N , : - 1 JOHN HARRISON LANDSCAPING P O Box 312 Laurel, NY 11948-0312 (631) 298-4696 FAX(631) 298-9480 1-800-640-0136 February 15, 2001 Southold Town Building Department Main Road Southold, NY 11971 Dear Sirs, This letter is attached to a permit for a Fence. Presently pending with the Building Dept are two permits for a pool and tennis court. The enclosure fence will run from the rear of the house to the property line around the rear of property along the perimeter and back to the rear of the house, the fence will meet Southold Town Building Dept. requirements for a pool enclosure and will be 4"0" in height. Around4he4xo osed tennis court will be a fen ng own the sides of the court fora fence on the s' a court will be a 4"0" fence for a total enclosure of the court. If you have any questions please do not hesitate to contact me. Sincerely, John C. Harrison NYS Certified Pesticide Applicator Suffolk County Home Improvement License JOHN HARRISON LANDSCAPING 2 P O Box 312 Laurel, NY 11948-0312 (631) 298-4696 FAX(631) 298-9480 1-800-640-0136 December 12, 2000 Proposed tennis Court Installation Square Footage Calculations House & Garage 2116 sq. ft Deck 629 sq. ft . Proposed Pool 900 sq. ft. Proposed Tennis Court 7200 sq. ft. Total 10,845 sq. ft. 20% of total lot 17,557 sq. ft. NYS Certified Pesticide Applicator Suffolk County Home Improvement License � 7/SSS BUILDING PERMIT REVIEW CHECK LIST DATE REVIEWED: APPLICANT NAME: ell T rd AC er- DATE SUBMITTED / / SCTM# --- DISTRICT: 1,000 SECTION: /oo BLOCK: LOT: ¢3 PROJECT LOCATION AND TYPE OF PROPOSED WORK: / PROJECT DESCRIPTION: ADD,ALT,6d OR N/D: 4, �'Xi1 STREET: rJs:.4 AirCITY: /Uw„,Tv�„ SUBDIV. NAME: ARCHITECT/ENGINEER: /Zrr, sa`J Low7SCo�� rC FAST TRACK: YES N SINGLE& SEPARATE CERTIFICATION-REQUIRED: YES ORCO OTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83 ZONING: PERMIT EST ATE AMOUNT:_$ 3.I(l .00 PERMIT USE: EXISTING: INTENDED: ZONING DISTRICT. R40 80 AC CONFORMIN (YES NO REQUIRED LOT SIZE: SQFT. WHERE ACTUAL LOT SIZE FROM TAx CARD ACTUAL LOT SIZE: ")kj SQFT. jp/ REQUIRED i)IRED REQUIRED FRONTSO 'PROPOSED: SIDE YD: /S ' PROPOSED: '/ REAR:SC) 'PROPOSED: LOT COVERA ALLOWED: ,a %o EXISTING: sf_% NEW: sf_% TOTAL:10-15d", /° CORNER? ES R NO WAT ER FRONT? YES DESCRIPTION: FLOOD COMPLIANCE ZONE: PRE-FIRM 3/18/80 PANEL #: // of� FLOOD ZONE: AGENCY PERMITS REQUIRED FOR REVIEW INCLUDED IN APP KATION TOWN SPETIC PERMIT: YES or SUFFOLK COUNTY HEALTH DEPT: YES or O (BED#): DTE: / / PERMIT#:RI0- NEW YORK STATE DEC: PRE-DEC 9/1/75 YESor SOUTHOLD TOWN TRUSTEES: YES or TOWN ZONING BOARD APPROVAL: YES o TOWN PLAN. BOARD APPROVAL: YES or NYS ENERGY: YES OR NO EGRESS: VENT: LIGHT: OTES: 3 /6 P)rr s , 311-1 s FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR :_2Z-66 SF SECOND FLR SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE T( 21 U SF)- SGI 0 SF)= G,20 6 SF X $ X20 =$ 12'0'6 +$ 3S- +$ = $ /2�S FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE; March 13, 2001 TO John Harrison A/C Nancy Stroker PO Box 312 Laurel NY 11948 Please take notice that your application dated February 15, 2001 For permit for fence enclosure to accessory tennis court at Location of property 50 Harborview Ave Mattituck County Tax Map No. 1000 - Section 100 Block 1 Lot 43 Subdivision Filed Map # Lot# Is returned herewith and disapproved on the following grounds proposed fence enclosure around accessory tennis court not permitted pursuant to Article XXHI Section 100231B which states-, Fences, walls or berms may be erected and maintained subject to the following height limitations: B. When located in or along side and rear yards, the same shall not exceed six and one-half 6 1/2) feet in height. Applicant requesting a fence enclosure up to 8 feet in height -------------_---_=-- - ------------- uthorized i i ature 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ]/FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE f D INSPECTO 765-1802 - - BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ l FOUNDATION 2ND [ ] INSULATION [ l FRAMING FINAL [ l FIREPLACE & CHIMNEY REMARKS: U DATE /� o> INSPECTOR FIEtD INSPECTION REPORT HATE C014MNTSv FOUNDATION OST) Ilrr --JI I 0 1j C �� IIV1 FOUNDATION (2ND) II p _ t� ___-- ------_-- - - ------------------------------= to ROIIGH FRAME & �—JI PLUMBING II q ------------- y � INSOLATION PER N. Y. i! STATE ENERGY CODE u �I %f I H I N L FINAL ADDITIONAL COMMENTS: 1 aZ dol 12,140161 �a , - d BOARD OF HEALTH FORM NO. 1 3 SETS OF PLANS . . . . . ... . TORN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . ... . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . .... . . . . . . m,--_,7 TOWN HALL SEPTIC FORM . . . . . . . _.. SOUTHOLD, N.Y. 11971 DEC .. .S. . ... . . .... ....... . . . TEL: 765-1802 TRUSTEE . . . . . . . . .. . . ...... . . . . NOTIFY: CALL Examined.. .......... 100/„ MAIL Approved.....r3b`l....., ZOO/ Permit No. .. .................................. Disapproved a/c .................................. .................................. .............................................. ..... .. . ............. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date. AA-t?or. . . . . . . . .. 2GQQ. INSTRUCTIONS a. lois application must be completely filled in by typewriter or in ink and sut nitted to the lkiilding Inspector 1. 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan shying 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 application. 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 issue 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 UWW MALS to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Canty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in bqJ14UiWfor necessary inspections. (Si re of applicant, or name, if'a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builds ...... ..A 1?14 r................................................................................... Name of owner of premises ....f-AAn lCrq.. �............................................................. (as on the tax roll or latest deed) If applioant is a corporation, signature of duly authorized officer. .. .................. .............................. ..... . (Name and title of corporate officer) Builders License No. ....... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... z 1. Location of land on which proposed work will be done.............................................................. 0.6glon House Number Street llammlet Canty Tmn Map No. 1000 Section .... ...... Block .... ........... int .. Z.......... Subdivision ...................................... Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intepded use:z�nclegccupanxy q proposed construction: a. Existing use and occupancy ...bhcy.vmvo... ............. "`......................... ......... b. Intended use and occupancy ..... �AQA!C`' .... ................................................ . . .. -^-•• t. .......... exw►[ion .. Alteration ......Repair ......... ........ .... Removal ............. Demolition ............ Other Work .TkT.•!tpj,5 fc� sem".......... (Description) 4. Estimated Cost .TJr,?.MG21.2(�........ 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, specify nature and extent of each type of use,.;., 7. Dimensions of existing structures, if any: Fr0nL....... ... Rear ...•..•..... ...... ......... Depth ................. Height ......................... Number of Stories ...................... Dimensions of same structure with alterations or additions: Front Depth Rear ............... Height .................... Number of Stories . ......... 8. Dimensions of entire new /� , ... construction: Front ......c4V...... Rear ....lO L?...... Depth Height ..........Q............. Number of Stories ............. 9. Size of lot: [Yuri' ....�.c 1%4.......... Rear ......t(5?I.. 4. � �.. ..... Depth ... .......... 10. Date of Purchase ..................... Name of Former Owner ...:.-XL):Clrll........... ............. 11. Zone or use district in which premises are situated ` .46 12. Does proposed construction violate any zoning law, ordinance or regulation: ......Pp.......... 13. Will lot be regraded ..... **J-0......... Will e=ess fill be removed from , preuuses• YES *� 14. Names of Owner of premises . t•(Ad�K.4.g[lzp '1/,r„ Address ((ole�?v.All�► ,Stl(QA 1 nlC,. Phone No.$2,3: .4U Name of Architect Address n.............................. Phone No. ..... Name of Contractor ...jLoaV4. :.(4A ........ Address .P0.wgs0)4.ZlU �Qt 44,N.. Hnone No. 15. Is this property within 300 feet of a tidal wetland? * M *IF YES, SOUdI D 1UM TRUSIFES PERMIT HAY BE �[da. N[) x .. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensi from property lines. Give street and block number or description according to deed, and show street names and indons icate whether interior or corner lot. S�'E P-"ITF�6EC� • w TNIE OF KW Y(xuc, �S UONIY 0fV.EFot.Y,-......... ••••...............being duly sworn, deposes and says that he is the applicant Nene of individual signing contract) bove Hared, e is the ...... Cv ...... .............................................. (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said-work and to make and file this Iyp"cation; that 01 statements contained in this aj4)1ication are true to the best of this knowledge and.belief; and hat the work will be performed in the manner set forth in the application filed therewith. :corn to before me this v� 'f 1+ .....day of .. r/C :2i'0 U� Notary PubliY % ........... (Si lure of Applicant) Nor "t♦ YAR[�ARETC.RUTKOMI9R Ofty Public,^tate of plow Y4k 4 pmko•. —... QWlfieo m E iuok coag (J p�u+erm�e�ert,