HomeMy WebLinkAbout29933-Z FORM NO.. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29991 Date: 02/03/04
THIS CERTIFIES'. that the building ADDITION
'Location of Property: 125 BOW RD SOUTHOLD
(HOUSE NO.) (STREET). (HAMLET)
County Tax Clap No- 473889 Section 87 Block 2 Lot 33
a
Suhdiivision Filed. Map No hot NO.
:conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 11, 2003 pursuant to which
Building Permit No. 29933.-Z dated DECEMBER 11, 2003
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 SCREEN PORCH ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED
FOR, & AS PER CERTIFICATION OF LAWRENCE M. TUTHILL, P.E. DATED 1/13,/04.
The certificate is issued to ANTHONY & BARBARA LEWANDOWSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO- 1190292 01/20/04
PLUMBERS CERTIFICATION DATED N/A
Au orized Signature
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)
PE1� -LIOC 2993.3 Z Date DECEMBER 11, 2003
Permission is hereby granted to:
ANTHONY & WF LEWANDOWSKI
PO BOX 448
SOUTHOLD,NY 11971
for
CONSTRUCT A SCREENED PORCH ADDITION TO AN EXISTING ONE FAMILY
DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP#14847 .
at premises located at 125 BOW RD SOUTHOLD
County Tax Map No. 473889 Section 087 Block 0002 Lot No. 033
pursuant to application dated DECEMBER 11, 2003 "and approved by the
Building Inspector to expire on JUNE 11, 20
Fee $ 150 . 00
i
uth iC ature
ORIGINAL
Rev. 5/8/02
X77—� yip
15 1u�s RI Form No.6.
I j TOWN OF SOUTHOLD
" Mn� U BUILDING DEPARTMENT
N TOWN HALL
1 765-1802
SSC DPT.. €
n, °d ;r-oma HOLD
` APPLICATIOlaT FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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).
t 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.
B. For existing buildings(prior to April 9,1957)non-conforming uses,or buildings and"pre-existing"land uses:
1. Accurate survey of property shoving all property lines, streets,building and unusual natural or topographic
features.
2. A properly completed application and 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.
I
C. Fees
1. Certificate g%.`Occupancy-New dwelling$25.00,Additions to dwelling$25,00,Alterations to dwelling$25.00,
Swimmingpool$25.00,Accessory building$25.00,Additions to accessory building$25.00, Businesses $50.00,
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00
Date. ��C
New Construction: I Old or Pre-existing Building: f (check one)
Location of Property: /� 600 Aqd Jp4 r2a/cr
House No. )) Street / Hamlet
Owner or Owners of Property: b q de rL Lucile
Suffolk County Tax Map No 1000, Section 87 Block a Lot �3
Subdivision Nu pma kvmQ 60Qc Wo Filed Map. /a(p // Lot: /s
Permit No. Aq?33 Date of Permit. �aL/0.3 Applicant: (iQd4 P [W44do0ek,
Health Dept. Approval: Nrr4 Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: ✓ (check one)
Fee Submitted: $
L L/ Applicdfif gignature
if0 � X11/
s.y
TOW ' 0 5f
OWNER STREET
VILLAGE DIST. SUB, LOT
/�dS°
y %` n f �
u.�r �;, 4^.1.4s✓'.av 10f):.:�' �;' �/-'`�/� led,
FORM911 OWNER N E ACR,
p 5 W TYPE OF BUILDING
RES.,% G SEAS. VL FARM COMM. CB, MICS, Mkt. Value
ao�� 1
LAND IMP. . TOTAL DATE REMARKS
0 o S a o Uv P .5- p pe x w, -r ' f3 e a., /" W
v l o n a Ali t �b z
w Cs "2 7 r. " d ra t 5"3 v+�- " est r. . n
AGE - BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
Meadowland DEPTH
House Plot BULKHEAD
Total `- '"' DOCK
4�
p COLOR K(j Tu R pto TRIM N r E
t
� I 9
3
M. Bldg. a 5 —
3 J - 8 a sso
Extension /S f
Extension ! X t 3 i3 taf�
Extension l
i
Foundation Bath 1 Dinette
Porch Basement. /=u 1 _ Floors, p K.
Porci� Ext. as tenor Finish 7
ruv �.-X Walls— 2 / 1 2— Wp .5 FJrnrG[ SMfE' ' Rc CF• LR.
- Fire Place y Heat / t J DR.
2....
GarageS, - T e Roof 4. Rooms 7'st Floor BR.
_ f
Patio Recreation 'Room Roo6is find Floor FIN. B
O. B. Donner Driveway
Total
iy ,
i
o �r�rrLnr�rrr�r�LlGnr�L�r�C.I�rr1rSr..I�G�r�f�r�CJ7r�r�r�l�C 'r:�rr�u�r�r�r�r..rCJ7nr�l:nr�r�l�r�r ® .:.
BY THIS CERTIFICATE 0000MPLIANCE THE
5 NEW YORK BOARD OF FIRE UNDERWRITER
5 BUREAU OF ELECTRICITY 5
�j 40 FULTON STREET — NEW YORK, NY 10038
SCERTIFIES THAT
Upon the application of upon premises owned by
J1M RICH BARBARA LEWANDOWSKI
555'REYDON DR 125 BOW ROAD
SOUTHOLD,NY 11971 SOUTHOLD,NY 11971
Located at 125 BOW ROAD SOUTHOLD, NY 11971
i
Application Number: 1190292 Certificate Number: 1190292
S Section: Block: Lot: Building Permit: BDC: nsl1
eDescribed as a Residential occupancy,wherein the premises electrical system consisting of
5 'electrical devices and wiring,described below,located in/on the premises at:
5 First Floor, SCREEN PORCH,Outside,Porch/Deck,
was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was
i
found to be in compliance therewith on the 20th Day of January,2004.
.Name QTY Rate Rating Circuit Type
Miscellaneous
AS BUILT 1988
work exposed for inspection
Wiring and Devices
Switch 1 0 General Purpose
5 Receptacle 1 0 General Purpose
}Paddle Fan 1 0
A visual inspection,of the delineated electrical installation,determined that an obvioushazard is not present and the installation is believed to be
in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system.
7
' seal
1 of 1
This certificate may not be altered in anyway and is validated only by the presence of a raised seal at the location indicated.
rULjj JUtPrJLjEj"arFr3jQj 11�rJjBIfUl�r.PcPcPtPi ;:111rJ�rJr�cPcforJ��PcPcPrJ�rJ�tTrJ�r�rJ arJ@PrJ�rJJ�f�far�cPrJ�cfrJ arJ�rJ�tPrJ�cforPrJ�rJ�rJ�rJ��PrJr�rJ�rJ�rJ� X777
LAWRENCE M.TUTHILL
PROFESSIONAL ENGINEER
P.O. BO)<162
- GREENPOR7 N.Y. 11944
(631)477-1652
Southold Town Building Department
Southold Town Hall
i Main Road
Southold, V.Y. 11971
To whom it may concern,
I have inspected the construction of a deck and screened
porch at Bow= road; Southold belonging to Mrs. Barbara Lewandowski.
It is my professional judgement and opinion that the construction
of these projects meet the building codes for which they were
permitted. !
Permit numbers 29935-Z, and 29933-Z.
k
Lawrence . M. Tuthill
i
¢R -F NEW
Ir
a.
pp c4 L 5y;.
U'
0322-
OF a:
s � aceta
-_J -
1 ,
TFPEF r��G
J
MAW
y b
ED LAtjo
LEIS
+r #ee®z✓
E w Y 00 _
SU.e✓EY,F'o,F• �f•U1�fO.PJY�'7/i5�•P13.9.t�i�,�E1[G9�c%2'iu/�iX> A .sWO:�r�s�tt1Q �Ki•
:LarRT�iV �oyJ':,raG�t �oFs�aurL�autss-vT��/.Y �
-77
II
BUILDING Darr.
j
] FOUNDATION 1ST ROUGH PLBG.
FOU DATION 2ND [ 1 INSULATION `uc�Qs
!ND C ] FINAL
NE ARKS f
r
1b /�
1
E, Ji Al U -
��I;t ®ATS INSPECTOR
33
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ } ROUGH PLBG.
] FOUNDATION 2ND [ ]' IN LATION'
FRAMING [ . FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: L-
n
i€
DATE INSPECTOR
;t
1ELD ;;vSPECTION I IDA TE ii COMi4LINTS .�
OUNDATION 1st }
2UNDATIOP•; ( 2nd ) e
UGH FRAME
3PLt�r�a� �aG. —a
j NSxJLATTO d PER N . Y.
STATE ENERGY
CODE
s
g 1 —i3
F .r NA i. 1
— ADDITIOiNAL C<OMMENTS9
a G
.c
' rn
rn
y
j Ojr
TOWN,, E SOUTHOL D
BUILD1NC�t7E§AF3TMEI T i ;� i 3 0 10 hsl
t. #
..TOVVN:'HAILL
,
vOi)l kf0l TS ' 1,'�'. 91971
1T SLOG: DEF"
y } TEL 7 1802 Fgy B iJF SOUi OLD
�A r�
sxantified 0k, Received. . . , x 19
kPptoved ,�19 Perrnit No 4,
XsapProteda;c s i T 3
'1 k � it .. r
! # e+77 y
( ulldmr}lnspector), I• L h.
A LID TION OR 01lI LDING PERMIT �
} Data
INSTRUTCTIONS
I` a. This application must be'completely filled in,by
type�vr tenor in ink any submitted to the Building Inspector, with 3
i`
As of pians,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 �lr public str�ets
r areas, and,giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
rtion. ,
c; The work caveled by this application may not be commenced before issuance of Building Permit.
d: Upon approval of this app}ieation,theBuilding Inspector will issued a Building Permit to the applicant. Such pent
fall be kept non the preniises available for inspection throughout the work.- I
e No building shall be occupied or used in whole or in part for anyp rpose whatever unto a Certificate of Occupan�y
:all have been granted lay the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
uilding Zone Ordinance of the gown of Southold, Suffolk County, New York, and other applicable Laws, ordinances or
egulations, fdr the construction of buildings,"additions or alterations, or'for removal or demolition, as herein described.
be applicantagrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necessary inspections.
(Signat=ure of applicant, or name, if a corporation)
X y
(Mailing address of app icant)
i
;tate
fwhetne ,applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vame of owner of premises 3? ® �/c J !l�i�� f ?^�JG ?5, . . . . . . . . . .. . . . . . . . .
(as on the tax roll or latest deed)
f applicant is a corporation,signature of duly authorized officer.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name and title of corporate officer)
Builder's-License No. tt!?"r. . P e._ . . . . . . . . . .
m �
PIumber's License No. . . . . . . . . • . . . . . ._ . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
Otlie7•Trades License No. . :. . . . . . . . . . . . . . . . , . .
Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . 'L . . . . . . . . . . . . ; . . . . . . , .
Y
u . . . . . . . . . . . . . . . . . . . . . .a. dv a. . .I. . . .
. . . . . . . . . . . . . . ..
House Number,,ifA a P ,, Street Hamlet
County Tax map No. `-1 Section . . . . . . '� . . . . . Block . . . . . .6=. . . . . . . . . . Lot_ : . ..� .. . . . . . .
.
Subdivision �.. . . ... .. . . . . Filed Iviap No. . . . . . . . . . . . . . Lot . r/.�. . . . . . . . .
y x s
..,:is i". y n•, .r r7 .... _. . •am- o .. -i j.:J !!1.., ! ,. r J• -
.d . . . . , .
u u;i}:il;:: . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .
3. Nat�ere of work(check which applicable): New Pudding . . . . . . . . . . Adria„.gas . . : : .; Alteration . . . . . . . . . .
Repair . . . . . . . . . . . . . . Removal . . . . . . . . : . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . .
�+
(Description)
�rrf,<,J�% . . . . : :. . Fee . �'. . . a . . . . . : . . . . . . . . . . .
4. Es?iruated Cost . . .: . . . . . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
g, number•of d "
5. Ifdw=llin". � willing units . . , . . . ._ . . . .
g . . . Number of dwel ing units on each floor . . . . i
If garage,number of cars . . . . . . , . . . . .
6. if business, commercial or mixed occupancy, specify nature and extent of each type of use .
7, Dimensicns of existing structures, if any: front . , . . Rear . . . . .. .. . Depth :, . . . . . .
height . . . .. . . . . . . . . . . Nuanber of Stories . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dimensions of same structure i iih alterations or additions Front . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . .
Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . , . . . . Number of Stories .. . . . . . . . . . . . . . . . . . . . .
,8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . : Rear . . . . . . , , . . . . . . . Depth . . :. . . . . , . . . . . . `;
.
I:eight . . . . . . . . . . . . . . . ii II
Number of�tOCS . . . , . . . . :`. . . . , . ... . ... . . . . . . , . . . . . . . . . . . . . . .,. . . . . . . . . . . . . .
{
9. Size of lot; Front . . . . . . . . . . : . . : . . . . . . . . Rear . . . ... . . . . . . . . . . : . . . Depth . . . . . . . . . . . . . . . . . . . . . .
14. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner
11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 2.. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . .
13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No
14. Mine of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . , . . . . . . . . . . . , . . . . .Phone No. , . . . . . . . . . . . . . .
Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . .",. . . . . . . . . . . . . . . . .Phone No: . . . . . . . . .
Name of Contractor . . . . . . . . . . . Address . . . . . . . . Phone No... . . . . .
15. Is "Mis property located within 304 feet of a tidal wetland? *yes . No_,:G.. .
*If ves, Southold Toum Trustees Permit may ireeg u�ired.
PLO'17 DIAGRAM
Locats 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.
'''yyy{3 t{
V,
- tip '.. q "(
f
x, F3
a I
TATE OF NEWYORK,
'®UN'I'X OF . . . . . . . . . . . . . . . . . S.S
T
. . . . . . . . . . . . . . . . . . . . . . .I. . . . . . . , . . . , . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
Bove named.
eisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ,
(Contractor, agent, corporate officer, etc.) '.
f said owner or owners, and s duly authorized to
perform or have performed the said vrork and to make and file this. r
pplication: that all statements contained in this application are true to the best of his knowledge and belief;and that the
-ork wall be performed in the manner set forth in the application Bled therewith,
wom to before nae this e
. . . . . .day o. . � 19 . .
otaay:Public, . . . . . .a: !. . . .`. , , Q,4 r!�e.. County
sib . . . . . . - . . . . . . . . . . . . . . . . ... . . . . . ,
(Signature of applicant)
Baa.t '7
TOWN OF SOUTHOLD BUILDINCr PERMIT APPLIGATION CIMCKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN$ALL .. I Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: (631)76571802 Planning Board approval
FAX: ('631)765-0502 Survey
www.4orthfoda .net/Southold/ PERMIT NO. Check
Septic Fomr
i' Trustees
Examined. ,20 - -Contact:
Approved 20 Mail tot
Disapproved a/c -
fPhone:
f Expiration 20_ cf-7-7
Building Inspector
APPLICATION FOR BUILDING PERMIT
(EC 1 120
'
Date 20 6-5
t i INSTRUCTIONS
a s 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 r.e�schedule.
b.Plot plan showing location of lot and ofbu building's-or premises,relationship to adjoining premises or public streets or
areas, and waterways.
` 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 a permit
shall be kept on thepremises available for inspection throughout the work.
e.No building shall be occupied'or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months. Thereafter,a new permit shall be required,
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Ili I 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 corporation)
it
(Mailing address of applicant)
VIII
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
�i I,I
DA-,Aci kte< (yd Lowsµ. o-F A-TTaKNY
Name of owner of premises IJhRBA.K-w
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. A-S 6w �1
Plumbers License No. hlc�nta � l�CuwKu.cEcc I{eo+r
Electricians License No. No a. ^l e (EIC-4I
I,
Other Trade's License No.
Location of land on which proposed work will be done:
1 .
2 0%,A Roe's
Souse Number Street Hamlet
IIS
County Tax Map No. 1000 Section e-7 Block 2 Lot 33
I�I
Subdivision W O'T�—+ % Filed Map No. 9-1 7— Lot t '
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 5 r F,k•� , t (�o w.a
b. Intended use and occupancy 5 M N12
3. Nature of work(check which applicable): New Building Addition k' Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost A-5 8u,ur CSYDo:'=') Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units I Number of dwelling units on each floor I
If garage,number of cars I c w.
i
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any. Front 5Z Rear $o Depth Z S Y"
Height : Number of Stories '2_:
Dimensions of same structure with alterations or additions: Front G Z Rear z
Depth 2 -(" 64-A-) Height 28'�` C,,to &) Number ofStorie 'v� 2—
8. Dimensions of entire new construction: Front t;'Z Rear 2 Depth Z4? -�'
Height 2,U G" Number of Stories 1-
9. Size of lot: Front Rear Depth
10. Date of Purchase 15(.V( r ame of Folner Owner
11. Zone or use district in which premises are situated- w 2(d'j-rc w�
f
12. Does proposed construction violate any zoning law, ordinance or,reguiation? YES NO�
f
13. Will lot be re-graded?YES NOXWill excess fill be removed from.premises? YES NO k
14.Names of Owner of premises &-wL6*o-w (address Phone No.
Name of Architect Lome.j Address l rlt,_�'r Dr G n. Phone No `f7"7 —f(. SZ
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO X
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? *YES NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
h
I'
16. Provide survey, to scale, with accurate foundation plan and distances to property lines. $dr C-' OPT.
17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
STATE OF NEW YORK) [
SS;
COUNTY OF )
Te.Y c-5✓k L. tQ C cfi being duly swom, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the C3KIT.
(Contractor,Agent,Corporate Officer, etc.)
of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief;.and that the work will be
performed in the manner set forth in the application filed therewith.
t`
Sworn to before me this E`
Tlf dayof O ZGMdE,' 20xj
Notary Public Si ture of Applicant
,NOWY 1 M�dNe°Y re'(
No 01004&tr"-t
ousa%d in SO* unh 1
r
i
t
-Joe 77
P QVED A$_ NOTED {
DATE' �� RIP
FEE.X73, -- ICY,
NOTIFY BUILDING DEPARTMENT A1`
705.1802 9 SAA TO 4 PM FOR THE r
OCCUPANCY OR
FOLLOWINGigDA' IOhl IWO RE V o r
I Ftau��a�Yto+� ��tma F�EOUIRED
N t(� h�( �t� � � [[[[ FOR POURE[T CONCRETE
\ � 1e,a U1�8.d t i�RJi. i X OUG41 F4AMING & FLUf191t31NCx ® F
X INSULATION
�FR WITHOUT CERTIFICATECk4C OPEO
�� {{ ALL .QMr0!kUC$1,OAt SHALL MEET
OF CCR) CY THF,HFOUtPUNItNTS OF THE NX
E p "NTRESPONSIBLESCQtiOENERGY
FFOR .
MSE&C h9 Off -;0 4TRUCTtOR EARORS.
II!
saexa _ _ ----------------- ._ r 4
a
le
p
Ji
zl�rl
4
R
,Jp / zd
�t
S p
o
�a �O✓9Cr /p� o; � 'S ��
O � 1
4
. S
1
f'.
M
I
4
4
L. V
� A N
I
1
( f
{
Y
S vie
i f �
s
, 7
�{ h
v
i
� . ,
r
W "r
ul
5..
77 1
f
�
or
�.
1 1
,
Cf
I
f
„ •• � �j �. T, - ".�� '-1i '�- �y :� - � �. 1 �' I �- i ! �^ , . ..'1`I II_^_ 'r � - �, � qi>, i I
a322sn
-
CL
TI
4 •' - ... (� kb '�uNr.T&YxKrS :'Pe�'�,-t r�5 t3`l�'3..___. �_� _#.Y - / L O l
I _ I
i
tQ
w "
I
D �
Q
0
f Q
1
I
I o
A
jY aL
p O
VC wtr Oa o
I — rl
taw"- 1
GeV
i ' I ii li, II
U
1
_ /cN�irwro
032354-1
�OFESSIO'll
At
w
0
W
I
:4a 'Q ('
IL
11 I
" r .
e" 11 [r,r. ' : ": ., n: ', ; .-.: . . ,. .i 1; 1 _ �_...- LY3
1 . Ii '4 v .._,.�-,. I.Ilo ., , '.,.I.} .,- - .c , wet,_ ..(, Y
x,, . . �. ., a,' f ', ,- . . - r, . r,r,
,+, RR yy
f4Y
i .f 'F 1 ., , r -. .r V - I - — "yY'.-"'e•W�,�,r,rW�.r'-I,..i,.-,• •.1 !1
4 yI-f I- '{ ': r `. e - - IF«,-n2r�F- „Si3�"' ,-.-yam, - .•'I
.,
11
r ,. l , ,,,: : -.x a
e ,,, J
jlIc 11•' Lr'd"' ^P ,,,,*I- y, 4v; -,. .,, . a' a' ,r
N
A % k WL ' + -Lr^, ,: :F :J" ,,,,l r _ 1 ..V' 11
. �'.
� ,
w11 I Y r r. Z 1 ,, r, i A L _ 1 ., - .
� ` � II ur, I r i - 4 7 .
�I
x _" r:,'
'41.
4 f - 1 �'
�'
r•rilt z '_sy, r { i 1 - i r .!
i_ �. - .. .«.^'„ "'-�7r'54 :_�!N.." }' '
il,
At - _ Ir
d - i - .:a
F ry a 1 - t f I DC7,-?X.�� ._.._._._.�.�
* { I.1. t r A11,11
�'T 1 , _ - ' 1 .1I''j I _,
V rtu r ! §_ Y , f x! }t {,. I, '�': ..74 - . LI1 1 .y
YJ
V S 4 _ _ _
wi 'S x• 5' �` _ - - - d l Lf F f
ir h d ¢,7f .M } �,� ;
r ; _,d l _ _ - _ v
1
4 t yyl 11 I A d. u! i'µi
I .1
h 1t , 1 4 ° ¢I 4 f I : LLL 4
6 1.
k ' - .
r< �Y
�` J1 r 4 ,� w ! r + i'L -"' �`1 w� . - y r �a• r i - °. , - {" !1-1+L i'' r, - - i' ` T
'64 _ f e,,: o - r. 1.'.. , .,, 1 . - } y.:r . y .� �{/y.}!i. 7nr.,,,.. w
r'"+7 " .p. ,t,. 1� { 9I 1t" ' CIS - t- _
t� :� �,Y>f #fire ., + Ill :f5r,'+Eaanr{4v:,/ ' - { 4 ^s.Lx �a .._ =,.r', w
3rn •,''rtl:yf v 'n? i ?ft {r r 1= .��" - ._.._„y t.^� - - _ _
{ c�Y r �F r- arf,l 6S$tiiL" ,f- ,y
I r I-.: c'`i "l r .s "1'.kli4#.N,1-k r'a' - Y L ,"XL : _
f ^,�III,r ' ".-' a,' , r tr:A, > 'sary t .I _ .^r- .ia 1°'.d be - :_,'. 4'feLS:.da:'-^'�^s _ „ r.,',�'
tiN 4 'A '�Y� 8 4r '.p J. ..'1 ala _ , - _ , .l ._�i� ._ 1::�+. « - - ,. -
.; 1 -
�', Y' 1 Y M' M. .r . *yam,( - - ,
$a i. a- y r . .,?r. S '.,4 - fi* '-"=^c`.:x^.a...,�,rM, w,c,,d;-t"r...._ '^.r:.-. + ,;
e s s _ rr -�Nd - a vj' ! 1 {1 ,, '' .. ^' t q qj.T,�_�" ll ' Ira': a:rw,re - `
`x , Y .t"r {�, z 1 ` yr(r I P, - 1� ; .'� .,k¢ t8!^r_r,'41!Ni+;- f"'�.- _-w...r -% ' �".7yy�''
� r s r t;., 4,z F +, ,',..� J . J .. . " s.. t: } -3.L-^ vn t-I - _
F
r.
V Jn J4 V11-, r �,5 1 S I _ rpt' .
�wf - I
J l T, r. � v t} € of a J}' II I ' 11,3 _ _ _H { _. . . .,
Ms, L friar r,t� F s} ! tl n /� � . - _ - - - --! _.' ""'-+s a ., I �i''f�'T,+n" "�rrR - _
ue ! $ v Y t` I r 1
x ,,,I
e qy .. -
1 r 4 :Ir 4t - .h- �`;t. i _ 1.,.�. , �W_'r'.;r..+ >x' f'� _
t is ^ ' 'a: 4 „�, 1; { 6 ti "_.1-, , , "---.. _ .-+.:."_,=`^+:1!"`S'- "„t+•'Yr�,a^`. ,�zb- ,. . rM
4�1
1 r .t`s s. r r -,:, N : kyr .r `r''I i I .. "_,s-._,..,t..� z-
J
1,Ef r, :�. t..,,,,;t , 11 .:, 'S ,. >a•' i.., - '4 .1 a t .•�; . 3.s 1-' rte. , 7, n'";-' .
+ �
bhw r .a " ,'- 'WA f t� _ r _ I , . 1 . . _'U::M'PA:a''r-_ - I'1 .
h Y ,. _
d' ,N_�:sr - tS�h? n } �� r. k; S � rti ,- � 4 }1} 1 `n'+'CirY. +.
u3 f • P v'4 ,, t 1 a _
1-1r v;. t e - C) ? .,+'I'1, ,S A. {r t.8 • i I ' .� :YF~ x t _»....._ .f1 __ - _j .._.,
r
If.., .r. t ;':e;%'3 _ i -il �,<.� ] .. i,_ `:_ : :Y.. 1 f !I _ t a _ r --"•.- ..,.--. -
N
.."v „#,..e 4 'u lw ,% AM.�f`. p f ' .1. _ I. .ti , I { q ,le .. Y,
r
fi.
y
r)q
III, ? r r l:fF i F tI a y'1 r, �;