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HomeMy WebLinkAbout17078-z . FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19912 Date MAY 15, 1991 THIS CERTIFIES that the building ADDITION Location of Progerty 1165 SALTAIRE WAY MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 100 Block 1 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 23, 1988 pursuant to which Building Permit No. 17078-Z dated JUNE 8, 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 AS APPLIED FOR The certificate is issued to ROBERT S. & DEBRA K. BALES (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-061540 - MARCH 14, 1989 PLUMBERS CERTIFICATION DATED JUNE 21, 1990-RBT BUGDIN PLUMBING & HEAT, -----`r`te---~- - ilding Inspector Rev. 1/81 nosas xo. s 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~ ~17~78 Z Date .......~°~'.~i~'~ 19.~t~ Permission is hereby gra ted t ro ..h~!~~4...e1-ra...........~z?~~.~..G.~.........r~~...- at premises located at ..../~~?..~~I~..~~.....sa~~?.R..t~~~'f/.l/rr......fo~..4?.'~.-.- Caunty Tax Map No. 1000 Section ........I.CJ..Q....... Block ................~..ccLot No.............~~....Jr..l.. pursuant to application doted 19..Cl.~ and approved by the Building Inspector. (J/~ Fee $....Crd.. py~ ildin~% for Rev. 6/30/80 ~ , Form No. 6 u` rr `a..., (cam-, I~~~~`, j~4 TOwN OF SOUTHOLD I ~ BUILDING DEPARTMENT I~AY 141991 TowN HALL 765-1802 y ~r APPLICATION FOR CERTIFICATE OF OCCUPANCY 9. This application must be filled in by typewriter OR ink and submitted 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 17 lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from archi=ect 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 Buildi-ng - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date few Construction.......II.... Old O~r~Pre-existing Building., nn .ocation of Property..l.~ ~a.z...:~a'~A~;-;~... ~~~.......<a~~~~,~u~,~C House No. ii treet Hamlet ~nwer or Owners of Property... ~O.~~jC'.r~ ..`:....~f'>~:1....~4~ Y~ ~ ~r~/.~P~' . , . :ounty Tax Map No 1000, Section.:jC~~,,,,,,,Block...... ~........Lot...../ ubdivision ....................................Filed Map............Lot.. / ermit No...,( ~~,,,Date Of Permit. ~..~'...~,~...Applicant.~~?;'!'~„`S„~,~h;~4..~; ~~~4/~' ealth Dept. Approval ..........................Underwriters Approval...~.~'.~tS, y lanning Board Approval equest for: Temporary Certificate........... Final Certicate. (J V ee Submitted: ,$/.,~,5,~,,,,,,,,,,,,,, I/, ~~cl ~ ~(0 77f . 1~~~~..~~ . Cn ~ ~ 9 9 APPLICANT Oc~~F F ~~5,~+ TEL. 7G5-1802 o~!! O~ TOWN OI' SO'UTIIOb,D l.::'^ ~ Litii"!Yr}' ~ OFFICE OF BUILDI24G INSPECTOR o i; ~ ~ `fie: '_3ti ~ rn P.O. BOX 728 ~ ~ ~ TOWN HALL 4`~"" j~ nn ~/j~o SOUTHOLD, N.Y. 11971 ' 3~~ ~ U C E R T ~ TOWN OF 5UU I F I C A T I O N --°~---'---~-~•..,v.., THULD Date ,y~~/,~~a Building Permit No. O p'~ g ~ , Owner .~rne 4~m~Y'-~-' ~l~Es (please print) Plur,.ber 2.O,C~~y /~~(s-!S/~ /QG~~-7-~"i'~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. C _ v G(plumber's signature) Sworn ~o before me this day of C~~1 ~'P/ 19~, + Not i~ Public ~ tlotary Public, S ~ ~ County , NOIMy MIBM 10/lbM?~ ~wgHe~b?'n ~y Commkeion Expires febrwry 't -I THE NEW YORK BOARD OF FIRE UNDERWRITERS t'F; Lrfi i ~ i,~'I L' ' L' BUREAU OF ELECTRICITY BS JOHN STREET, NEW YORK, NEW YORK 10038 Date Nft4;*fl 1~ i<iFg APPlication No. on fete :+Ft1"~j~«r~'jIHPS AI +h'e ;i 1~i' THIS CERTIFIES THAT only the electrical equipment as deacrihed 6eloty and introduced 6y the applicant named on the above application numher in the premises of N!l is3_('q i3 ti t.C'a'e `~Hi StiCl' 1•i rl?. i`Ill i; t~!II, 7 If.. iS F.i, 4i Ga 7'€'t ilKK. Pl, in tkefo/lotcing location; ? Basement ? Ist Fl. ? 2nd Fl. Section B/ock Lot uws examined on 1`~L; Ittt'iFllty ~ 7'+S'S'' aadfound [0 6e in contylianre with the reyuirentents of this Board. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DIiH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FIUORESCENi OTHEH MAi K W. AMT K W AMT. NW PMi K W AMT N P ,I ?`Z ~'7 .1 %1 I DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS EELL UNIT HEATERS MULTI.OIITLET DIMMERS AMi. K. W. Oll H. P GAS N. P. AMi NO. A W. G. AMT AMP AMi. AMPS, TRANS. AMi M P. SYSTEMS AMi WATiE NO.OF FEET i h(11f SERVICE DISCONNECT NO.OF S E R V I C E AMi M1p. TYPE METER 1,e' YW I ,e' 1W 3.9' ]W 3,e' 4W NO.OF CC COND. A W G. NO OF HbLEG A W. G A W G. EQUIP. PER % OF CC. COND OF HI-LEG NO Of NEUTRALS OF NEUTRAL 1 {fill [.:0 1 1 ry11:t 3 S.I!,? OTNER APPARATUS: IE(r,Ul:kki:J-3, It ~.~~I;~t1'IFFU BfihlhiC,i4'{' li , f- . I 1 s --'S ":•~IIJI=.E its~1S_i:lllk. z ~~''l iG?11 t;Nl~.!iHtRi dii, Ch, L tl:.ttit) ;S F ~!~i~~ t', SY, N{I 'i `i `i rl TJ?!?t1 f,O{iIJYi 1}V[-, GENERAL M NAGER ¢l tF 7~11111i.Y., 117, li-7 `I'F .E f~~_ Per ~y This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. TNIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS t'~IIL,r I Uirufr,t BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date t1F1Rl-11 UJ, 1`Pii'l APPlication No. on file 'z~~`b'~`"~`I p'(1rk I: Lh (`_~'i~ THIS CERTIFIES THAT only the electrical equipment its described below and introduced 6y the opplic¢nt Homed on the ¢bova application number in the premises of I~'!)I"<4i.f~i I,fili-:,~ `~Hf.7t11U 4Jt1YY F`+;rl(. i~10, (il.tt~, I~~Tftl~llC~}tf M. v', in thefollowinq loc¢tiong Basement ? lat Fl. ? 2nd Fl• Section Bfock Lot was examined art ¢nd fourzd to be in contpli¢nee with the requirements q(this Roard. FIXTURE ECEPTAGLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FIUOREJCENi OTHER AMT K W AMT. K W PMi KW AMi K.W AMT. H P. iT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REG'PT TIME GLOCNS BELL UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K. W. Oll M. P GAS N. P AMT NO. A. W G. AMi AMP. qMT. AMPS. TRANS. AMT H. P. SYSTEMS AMi WAIIS NO.OF FEET I r~fl:.l SERVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP, TYPE METER I q 1W I ,a JW 3 $ JW 3,6' 4W NO. OF CC COND. A W G EQUIP. PER Of CG COND NO OF HbIFG OF~H IEC NO OF NEUTRALS OF NEU1q~Al ~ S.'~! OTHER APPARA7U5: 1 { h.llkf+tSF t' S$ 1~117£~fi['ii'!9I }il Hy;~+'{,h'IE~dt Ca H'e t:, 4r, !i i91iH F_ tr f,~iFt. tl71,;_a f, H. ~{dI~N3h`[= :tllll ZTI.,f44~:t G~/~~ F',~1,nU~ .%1{3 t. fl l_Il h'11f91, ilJ, 1?'~'..:5 6ENERAI ~IAGER li r Per ~''t This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their cred COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANFIER. ~~a~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: F f I I 'i t I ` DATE INSPECTO •j6~ u _ _...._.,..r. _ ~ 765-1~ ' _ BUILDING DEPT. 1 NSPECTION [ ] FOUNOATid(d 1ST• ] ROUGH PLBG. , [ ] FOUNDATION' 2ND [ • ] INSULATION [ ] FRAMING ~ - [ ]FINAL REMARKS: i - V;: G DATE ~ ; , + INSPECTOR~~~/- ~ rGL._~,k2'~ 17 n~~ Tss-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] UGH PLBG. [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING 9~ ~ ]FINAL REMARKS: `'~'L"~ G~~ DATE r ~ INSPECTOR 1~Zo~8"~ 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [FOUNDATION 2ND [ ] INSULATION [ ]FRAMING [ ]FINAL REMARKS: ©t 4 4 DATE 2 ~ INSPEC'TOR~,~~~yta i;~ ;c.~~ / 7~ Z~" '~-x$02 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [)FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKSe C_ C~ L~~ f~ f~ DATE U 0 INSPECTOR ~"d'W: ~ . 765-1802 BUILDING DEPT. f NSPECTI4N [ ]FOUNDATION 1ST ( ]ROUGH PLBG. [ ]FOUNDATION 2ND [ }INSULATION [v~FRAMING ]FINAL REMARKS: ~ r ~ ~ _ ~ DATE ~ ~ C~ INSPECTO f , INSPECTORS ~~gpFFO(kc (516)765-1802 p O Gy SCOTT L. HARRIS, Supervisor VICTOR LESSARD, Principal ~ CURTIS HORTON, Senior r°n Z Southold Town Hall VINCENT R. WIECZOREK, Ordinance p P.O. Box 1179, 53095 Main Road ROBERT FISHER, Assistant Fire ~ Southold, New York 11971 Building Inspectors 0,( ~a Fax (516) 765-1823 Telephone (516) 765-1800 THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUT'HOLD February 28, 1991 Robert & Debra Bales 1165 Saltaire Way Mattituck, N.Y. 11935 Re: Building Permit #17078-Z (Addition) Premises: 1165 Saltair Way, Mattituck, N.Y. Suff.Co. Tax Map #1000-100-1-24 Dear Mr. & Mrs. Bales: During a review of our files, it was noted that the above building permit has expired and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold Article XXVIII 100-281 and 100-284 a building permit is needed for any construction of additions, accessory structures, alterations or new dwellings, and it is unlawful to occupy or use said structure until the Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Victor Lessard, Principal Building Inspector VL:gar :'1:;LD iCSPnCIU;] ~~UATn ~ COdKMEiNT° ~ V 'v 0 7. 7~ ~ ~V >±OUN~D~ATION (1 5't) ~ N 2 ~ c _ m FOUNDATIOtJ (2'fid} z. q 2 ~ o\ 2 y ROllGH FRAME & .Gt... PLUMBING s ~ 3. IIJSULATION PER N. Y. STATE ENERGY _ CODE ---~r~ a . .S" `3 -I y~ FIiJAL a ~ 3 u ADDITIOA]AL COMMENTS: _ _ S ~ l~C _ w H H H^ O ~91n' Z ~ Y x ' ~ x d ro b H (516) 7 5~ 802 o~pS~fFO(k~oG VICTOR LE5SARD, Principal y~ SCOTT L.HARRIS, Supervisor CURTIS HORTON, Senior y a Southold Town Hali VINCENT R. WIECZOREK, Ordinance "p P.O. Box 1179, 53095 Main Road ROBERT FISHER, Assistant Fire 9 ~ Southold, New York 11971 Buildin Ins ectors ~0,~ .~0 Fax (516) 765-1823 g P ~ Telephone (516) 765-1800 THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD February 28, 1991 Robert & Debra Bales 1165 Saltaire Way Mattituck, N.Y. 11935 Re: Building Permit #17078-Z (Addition) Premises: 1165 Saltair Way, Mattituck, N.Y. Suff.Co. Tax Map #1000-100-1-24 Dear Mr. & Mrs. Bales: During a review of our files, it was noted that the above building permit has expired and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold Article XXVIII 100-281 and 100-284 a building permit is needed for any construction of additions, accessory structures, alterations or new dwellings, and it is unlawful to occupy or use said structure until the Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Victor Lessard, Principal Building Inspector VL:gar 1 lcvy a ;07 ~ D~LIeS~~N ~ T \ Mil , . 50 ~Q~ ~ O t _ o ~ w m G o j ~ o i w L ' o ~ ~~E ~ ~ N / L I.I p-i ~ g ° G b ~ E" _ ~ Ct1 0 4Z r~ o ~ ~ O } N p Y ~f w K vl~ ` " 9~ N W 2 C.r L y.. O~~^ U, a c ?r' ~ k `'l1 ~ ~ R ps r ^ ~ ~,3~~9 f ~ o_ l V`- 6yo9~ $ ~ ( s ~ p£, E ~ ~ N N k ~ W ~ ~ o~i s ~ ~~d~~ds o M ~ 4 l ~d - - i i i t m t N r p 2 t ~ - n o + rzi~ >Ar'. a ~ OOH zoo o Zm{ ~~z c Oz7~ ~Z~ N n u. O O D nn~ v A r C z o I ~ ~ -i ~ zi~o 0 f x -I D b m m w O ~ C D (n n n n z ~ T. rn SA o ° ~ 0 O m m o m D ~ g°~~m z ~ ~ ~ m z wzoo.. m 2 N m ~ A n~3y ~ ~ ~ D A ~ Dp cn ~ i r = c fic~~~ ~ 2ooa Z p o fib A r Z~ ~ 'S~\~ ~ K n p m A n Z~ ~ ~a o yQ sp ~ ~ a ~ ~ 2 ? ~ a i o _%S°~. 9 m L c p o ~ ~ ~ a h; o o Q o~ x ~ a~ ~ A A4 by yr u 0 m ~ f °J~i~ 1- uei Z ~ OARD OF HEALTH 3 SETS OF PLANS ll FORM N0. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEP I FO M • TOWN HALL ~,r//~?~~~. SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL MAIL T0: Examined . ~~/Y... 19~~.j Approved 19~V Permit No. ~ h ~ Disapproved a/c V 23 ~ pllV BLDG. DE^T, TOWN OF SOUTHOLO (uildi nspector) APPLICATION FOR BUILDING PERMIT Date a 19 .r~.~ 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 lnspector 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 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 building for necessary inspections. (Signature of applicant, or name, `if a corpor/anon) II6.S SA"'~Rlrg ~R /l~~T,~l•~y~IC•,/V'~,I/`~SZ (Mailing ad ress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. n Name of owner of premises ~~"~er~•~•'•~A~QS-•!~~•°~••~~6r'4 NrcoSiq•:r3,Q,I~S•••,••• (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co~rp~or~atre officer) ~pF CalS ~ Builder's License No. ..."7~0 • • • ~I a~~F,~ ~',~j~g~ \ T Plumber's License No. • ~ ~ • ~ ~ t Electnclan s License No. ~ 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 C 0Off.......... Block ~ Lot 1............ . Lot . Subdivision ...SR 1~:~-.I,. 2 • . ~S• f/{TPf • • , , , , . Filed Map No. '7~~0. (Name) 2. State existing use and occupancy of premises and intended use and occujp~ancy of proposed construction: a. Existing use and occupancy h~J./e• • • ~ y • • • w / 1 • • • • • , • C J b. Intended use and occupancy h~./e • • , F'4•'M•r . , , , 1~• w••e_ ~'lrv~, J :I 3. Nature of work (check which applicable): New Building Addition J Alteration . Repair Removal , Demolition Other Work . r,1 (Description) 4., Estimated Cost . 9~ .'U`.~ Z? . . Fee , . (to be paid on filing this application) 5. If dwelling, number of dwelling µnits A4lo(i h . , f, , , , Number of dwelling units on each floor . If garage, number of cars /.tdf~.ii+ . , / , , • • , , . • • , 6. If business, commercial,qr-mi~Ced occupancy, ecify nature~and extent of each type of use . 7. Di ~ensions pf e7t istidg stxw lures, if any: Front ...ri~D,-.?...... ,Rear ..Y~. Depth ...t/.~.~.3 . . ' , ,2 ber of Stories , . ~....w.i.~ ..~A.Se.era,-'~ . e struetln;d,wi i ~ 'th alterations or additions: Front -S r ~ Rear . , :S.rvr.2 , , . ep ht ~ r' um~ Height , , , , , Number of Stories , , J . , w. c 1.4 . . " 8. D menSions of entrre neKt'constrµction: Front p a ' Rear ..../.(c+...... , . , De th . Height, . . ......Number of Stories w~lh 6t}:S,a:Y^°n~', , , . 9. Size of lot: Front 'l:n©.' . Rear ...1.00.:.............. Depth P. 5r. . 10. Date o .ruse chstrirt in which per ~ f R ~ ~ g• ' ' ' • Name of Former Owner ; ~ ~ 1 ~ lei Y!7 : ; U:dx.S G4~e~ . 11. Iona o Purchase mises are situated , , • • • , , , , 12.' Does proposed construction violate any zoning law, ordinance or regulation: , .N. , , , , , , , , , , , , , , 13. WIlI lot be regraded N.,p ......j , ...Will excess fill be re?~oved from premises: Yes No 14. Name of Owner of premises ~~??a^.~. , .13.q-I,e,$, , , , , ,Address , 1 ! 6.5 . S4~Tls.~f e. ~':"~'hone No, a 9$ :5r. r ®5.'.. . Name of Architect ,,,,,,,,,,•,,,,,Address.....,............,PhoneNo................ Name of Contractor . ..................Address ...................Phone No............:.. . PLOT DIAGRAM Locate cleazly 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. , STATE OF NEW YORK, S.S COUNTY OF . bAr J- • • • • • ~ • • • • • • • ~i4 / Q.~ • • . being duly sworn, deposes and says that he is the applicant (Name of individual si n'ng contract) above named. He is the (Contractor, agent, corporate officer, etc.) , of said owner or owners, and is dull authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are 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 me this G~~ . ............day of',....~~~ 19 Notary]?uJ~lic . .......:~~:~~~~;-1 :4'-~..... County ~ry n 9 U s p~W` UNDAJ~ ~'I'~ Notary' Public, let . No.~4822683,SutI°~~ppq~ I (Signature of applicant) term Ires pecembe E N ERC~Y CODE CALCUL,~,TION.S (Foa NON-ELEGT21G -l1EAr~ Foa.: ~.V e~ e PEa ~w.vy.~: ,/~enr~ /v4G~ pE.s~y,,, CniTEA.., 6000 ~eyaEE ~.ers DATED : S/L U~ _ 0.~4.~/OF S.A.~70F J UBSYSTEn~ AQEA 4esiyu ,4ccowro L)ES/y.U AGL O\vEG QEi\\AQ.kS - "U" U BTU BTUH EXTEQ/~Q \VACLS (0/3055) O.l7 E"XTE,d/QQ \VALLS (OPAQUE) yZ 9 ! 9 0 0$ /2 9 G~~ z /NL 1L- % 6 0 58 z 4 g o ppp/~ o.vo _ - GE/L/Nl,,S~,amF 7 / 9 O.'o3 /boa FLOO.2 ~t0~ 0.05 ~S2U i ' IMF/LTl].AT/6N c~yU~ ~~~~g U,S'fJ .uQ TES : To-raGS t I d ~ o S~pF NEW Yp9 yP ¢~~Em T~ ~ HEATING EQUIPMENT TO MEET 7813.23 - 758 EFF. TO THE BEST OF MY KNOWLEDGE, a ce a 5,f HEATING CONTROLS S10 MEET 7813.13 BELIEFS AND PROFESSIONAL r m RANGE 45 TO 75 DEGREES FAHRENHEIT. JUDGEMENT THESE PLANS ARE _ ~ m ~ e WATER HEATING PER 7813.31 THRD .38. IN COMPLIANCE WITH THE CODE. p 032254-0 @ PIPE INSULATION 7813.19 `~O WINDO'i75 -DOUBLE GLASS. G~ P90FESS10F~P CONSTRUCTION TO MEET N.Y.S. ENERGY CODE. _ t3 a ~ >/iP