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Home My WebLink About28016-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32291 Date: 04/16/07 THIS CERTIFIES that the building COMMERICAL BUILDING Location of Property: 46455 CR 48 (HOUSE NO.) County Tax Map No. 473889 Section 55 (STREET) Block 2 SOUTHOLD (HAMLET) Lot 20 SUbdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 20, 2001 pursuant to which Building Permit No. 28016-Z dated JANUARY 17, 2002 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 ALTERATIONS TO AN EXISTING COMMERCIAL BUILDING AS APPLIED FOR. The certificate is issued to ANTHONY PIERRERA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL C10-01-0010 10/25/01 ELECTRICAL CERTIFICATE NO. 3026549 03/26/07 PLUMBERS CERTIFICATION DATED 03/27/07 CUTCHOGUE EAST PLUMBING d Signature Rev. 1/81 '- Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO'WN HALL 765-1802 .~ fJJt53rn r2')7 , ~,1l-~ 11~15 :~C 'It ; APPLICATION FOR CERTIFICATE OF OCCUPANCY - .'" This application must be filled in by typewriter or ink and submitted to the Building Department with the{ollowing: A, 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 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 2/1 0 of I % 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 Plmming 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: I. Accurate survey of property showing 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 Certiticate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, SwilTUl1ing pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. CCJ1ificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate ofnrrnpancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. '3 /'2-7 /0/ Old or Pre-existing Building: V (check one) tkL..h '-tU', ~l.-.~LO M, I \ q 7 f Street Hamlet New Construction: Location of Propel1y: '-1 ( y.rr House No. Owner or Owners of Property: ~ 0 Suffolk COllI1ty Tax Map No 1000, Section f,q-fJL C:;-S- Block )" Lot do Subdivision Pennit No. 2..g-0 I , Filed Map. Lot: Date of Pennit. Applicant: Underwriters Approval: ~} Heallh Dept. Approval: Planning Board "Approval: Request for: Temporary Certificate Final CertifLcale: (check one) Fee Submitted: $ \o.(.,u &- L~ irrJ-L- ~,7;)0 &J.. co..!C .3Jc2 ~ I Applicant Signature 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. 28016 Z Date JANUARY 17, 2002 permission is hereby granted to: FRANK & LINDA FELL 2195 KERWIN BLVD. GREENPORT,NY 11944 for : ALTERATIONS TO AN EXISTING COMMERICAL BUILDING at premises located at 46455 CR 48 SOUTHOLD County Tax Map No. 473889 Section 055 Block 0002 Lot No. 020 pursuant to application dated NOVEMBER 20, 2001 and approved by the Building Inspector. Fee $ 200.00 ~iL' Authori ed Si~e ORIGINAL Rev. 2/19/98 ['. 1 ~. FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) .., ~\ci o ~ - .., ." "" ------------------------------------ FOUNDATION (2ND) b. ~ ~ ROUGH FRAMING & PLUMBING A ..r: 2 .J./.,2~ ~ __('VA .+. w- .h 8'- ~ ',w~ (' ~ /\. ;. 9 / / ~ A """'~ O!::=_/~7.. - / . ~ ....~, "II .v~ :,,; , .;:2 h'" ./~-, ~. ~ A-"'_..!" A/.~ -,,:....~ <'l,<< .....- ~ ~ -1J .,;:- t?h.-,b '~,,~ ~, t? _ # . /~~ ~ ' __ -: / , (> 1:l f)o...... ~ .-{/_'r; A" '~~~" ...I /, -" ~ ~ ~ f<\ FINAL I A J ..--. , ~/" ~/ ~ hl ~ /-< ~- c X<U4 "t.- ~ =: / I ~;4~.L ~ ~../~~_.P' ~ ~ r'J.-1 , A.... /~ -r / C:. 0',,//........ ~"J :[ &;; .., r:~ , j, .d.. hJ.A / P" _,,~ ~ ~ {.l- ciA M"j,d'/ L - "'''''_ //L /. .I/')'iif!' _ /' ,L 1..</<24';' ()u.. ,'. -14 / ~ ..5><7 rA?Z.- (Y/,A: '7[ V' ) ~~/J - { ...Y ~/_ LJ fA ~/- ~~- /'h;;? I....... .;le M')f lL,:n "-J "L{ O.J4 -,. _ ~./ L. / v IV ,v , />~/~U/#b- A ~ Ai:.- j / (' :-,. tJ \.....t/ .-/ A ~ _, / /0 t INSULATION PERN. Y. STATE ENERGY CODE ~ ~ ~ ADDITIONAL COMMENTS , . -- ~ _ /', .rL~ ......""...-, . 14/ff11.17 l/]fjii .7..;n rbf./...t. W>.f{-Jo/ Jh ( J ~ Le;dJ /ff'JIO;T ;r-jf,h"Jr rt:1lv-'v /\ /V -f~Gt/ L"t7.rf',~ ~/l ~ I J / _ '-"'" /1 , '~ /1___/ 14/Ii)fAl 'hek.AkJS'f'7-CoTlJ'Y) ~'i55~- C'\./c:. ~ Ce). .f/.t.hIIlMJ '7 -, ! "'T\ ~ o I) :E fi ~ :0 0, I'" ...J ~ -.., ::J ~ o .., vJ ~ () o =c I ~ Q ~ ., =: '\ ~ Z ~ :-i \..J ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I Located at ~ Application Number: I Section: ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ; l!l. ~--- ~, BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS 40 BUREAU OF ELECTRICITY FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon prem ises owned by BARBARA MICHELSON PO BOX 1277 CUTCHOGUE, NY 11935 ANTHONY PIRRERA 239B E MAIN ST PATCHOGUE, NY 11772 46455 ROUTE 48 SOUTH OLD, NY 11971 3026549 Certificate Number: 3026549 Block: Building Permit: 28016 Lot: BDC: ns11 Commercial Described as a occupancy, wherein the premises electrical system consisting of . electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 26th Day of March, 2007. Name OTY Rate Ratio!! Circuit ~ Miscellaneous as built 2000 Alarm and Emergency Equipment Exit Light Sensor Appliances and Accessories Furnace Exhaust Fan Exhaust Fan Refrigerator/Freezer walk in type Wiring and Devices Outlet Fixture Fixture Outlet Receptacle Switch 3 0 2 0 Smoke 1 0 1 0 1 0 I 0 Oil F.H.P. H.P. 23 0 7 0 16 0 2] 0 16 0 8 0 Fixture Incandescent Flourescent General Purpose General Purpose General Purpose Invoice Total seal Continued on Next Page 1 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Amount ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I ~ ~ ~ ~ $0.00 $3.75 $2.50 $6.50 $2.75 $2.75 $13.00 $8.05 $2.45 $5.60 $7.35 $5.60 $2.80 $128.10 @].@] ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I Located at ~ Application Number: I Section: ~ ~ ~ ~ ~ ~ ~ ~ An as built inspection, of the delineated electrical installation, determined that an obvious hazard is not present and the installation is believed to ~ be in comfonnance with the applicable reference standard for the estimated period of construction of the premises wiring system. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ THIS IS YOUR RECEIPT ~ 2 of 2 ~ This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. ~ ~ BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS 40 BUREAU OF ELECTRICITY FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by BARBARA MICHELSON PO BOX 1277 CUTCHOGUE, NY 11935 ANTHONY PIRRERA 239B E MAIN ST PATCHOGUE, NY 11772 46455 ROUTE 48 SOUTHOLD, NY 11971 3026549 Certificate Number: 3026549 Block: Lot: Building Permit: 28016 BDC: ns11 Described as a Commercial occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 26th Day of March, 2007. Name Ory Rate Ratine: Circuit IxM seal ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Amount ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ T own Hall, 53095 Main Road P. O. Box \\79 Soulhold, NewYOI!< 1197\ Fax (516)765-1823 Telephone (516) 765-1802 , , OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD /~ ~l<i C E R T I FIe A T ION DATE: Building Permit No. Z SO ) ~ Owner: '13ztr-bvrA- f11lc he.l SoN / ~;Vi1~ CiW'l-try CCl t:'e. (please print) Plumber: J.cCt .c;~OL'/r Cufc;/Vj c-e ~ - f~ff 29 77- f (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. SuSAN J. NAGY Notary Public Slale of New Yor~ No. 4896735 QuaIKled in Suffolk County Commission Expires May 20~ Sworn to before ~ c2 ! day of Notary Public, me this 'Pj4 ~~7 County ! C2CE-Schwartz PHONE NO. 6317493289 ~. ~ ...-,.... ....,. - Mark~. Schwartz, AlA '- Architect, PLLC l".(J. llox 933 Cutchoguc, New York 11935 January 18. 2002 r'/ ) iD./Lft I~ g W R r"; lOll J'i...,I~'i Uu .., 22~fjj!: ~'l" '~'-' ! '-n'}--'~ ' . I I ~ ,.. Tn, \"/1 " [ ,," J ' ~1t. .' _, ,_ '. -"";-".~OlO Southold Town Building Department Main Road Southold. New York 11971 Attn: Mike Verity Re: Tex-Mex Single Service Wet Store (with 16 seat maximum) 46455 Route 48 Southold, New York SCTM# 1000-55-02-20 & 21 Frank and Linda Fell- Owners Dear Mike: Jan. 18 2002 01:37PM Pi 6P;;dgO/~ PI"",e: (631) 734 -4185 fax: <li11) 734 -4185 The hood system to be purchased by Mr. and Mrs. Fell shall be a system that will meet or exceed NFP A and New York State code requirements. An inspection and certification of the hood will be completed and submitted to your office prior to installation. Please call this office if you have any questions or require additional information Very truly yours, #to/fix 1'ell9..doc )-YO!c,* 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY (:CJ-- [ ] ROUGH PLBG. [ ] I~LATION [ ~INAL :) }'" t?LL7 b0- DATE sap ;t.---jNSPECTO / ;2 r{)J ~ + 765-1802 BUILDING DEPT. [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY REMARKS. ~~~A:49'-~ M~ O~ L~ INSPECTION [4GH PLBG. [ ] INSULATION [ ] FINAL ~AA/~ ~ 0. - - (5i ~~~ DATE .J/J,,t;J.2---- INSPECTOR / ~~~ oK %Dtb~ 765-1802 BUilDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY REMARKS:~~ ~ ~ A~~~ '7'- 102!W-,k/~ .- 7&~lCavLd;-~- ~~ I ~-( ~~?) Hk /~(--cJ~~) [ ] ROUGH PLBG. [ ] IN [ DATE .s-/;O /t; z--- INSPECTO I / ~ ilL - ~ :;L 1 dL, 71/';/ a4 f..M/' U, . /f/l. W /) 1/ () '3 /LtJtbJwid/ ;z Jo/0 C:: SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE5i CERTIFICATE OF APPROVAL OF FOOD SERVICE ESTABLISHMENT FOR CONSTRUCTION, AL TERA TION OR REMODELING Applicant Establishment Location Fell Restaurant 46455 Route 48 Southold, New York 11971 Approval is issued under the provisions of Article 13, Section 1304 of the Suffolk County Sanitary Code for: I) New Structure 3) x Conversion 2) Remodeling 4) Other ., THE FOLLOWING CONDITIONS APPLY: I) THAT THE PROPOSED CONSTRUCTION BE IN. CONFORMITY WITH THE PLANS AND SPECIFICATIONS APPROVED BY TIllS DEPARTMENT. 2) THAT THE APPLICANT CONTACT THE APPROPRIATE DISTRICT OFFICE OF THE FOOD CONTROL UNIT PRIOR TO OPERATION OF THE ESTABLISHMENT TO ARRANGE AN INSPECTION OF COMPLETED CONSTRUCTION. TIllS CERTIFICATE IS NOT A PERMIT TO OPERATE A FOOD SERVICE ESTABLISHMENT. OPERATION WITHOUT A SATISFACTORY PRE- OPERATIONAL INSPECTION AND/OR A PERMIT TO OPERATE WILL RESULT IN LEGAL ACTION. ~." 3) THAT THE APPLICANT SHALL ASSURE CONFORMANCE WITH THE FOLLOWING AMENDMENTS TO PLANS AND SPECIFICATIONS: a) Certificate of Authority. b) Provide adequate number of prep tables. ,IDII r> j"j ~ " \fl ~l~ 1"\ . II Ill! \ .\\1'1 2.20(2 . \ . \'" 1 .. \ L- RLOGDEPc urN!7'! F SOUTHOLO ISSUED FOR THE COMMISSIONER OF HEALTH H /20<-. //&-0\ DESIGNATED REPRESENTATIVE DATE TRAINING AND PLAN REVIEW UNIT 1700 UNION BL YD. ROOM 106 BAY SHORE, NEW YORK 11706 854.0411 STREET SOUTHOLD~PERTY if .55' VILLAGE () RECORD CARD . .. . /d()O - S$- .2. -),,0 TOWN OF OWNER DISTRICT SUB. LOT ~,i"':.~ Tillable. 3 ACREAGE ' .7;z.. TYPE OF BUILDING '/15" SEAS. FARM C I Est. Mkt. Value LAND IMP. ~._---..-- TOTAL DATE REMARKS ./..~ .z-,'l'Yf:f'~~t'd+6 :)'''''is I, k~ .3 4,"7 0 ..3G;66 6/C /I )..tt-(/ 0' d-;':' (>..-0 /::J(f ,) / / / a-tJ-O / r\\1l. '7 .36 0 ./ f--o /' ~ . ~.f-;'-"c. _ .3 C, 6-<1 ::cy /~E "3 NEW 212 Qlk> Tillable 2 Woodland Swampland , Brushl~d....... House Plot oJv ~ ;l/~b .., . - ~ . . -':""'"1 I 4/'Yoo I),,", I I I i I 'vi. Bldg. S' :;' " 90 ~ ).- i /J (j-.,,"/? /1 Foundation Pc. Bath 3 i 1~l3'ion Basement Floors I s~ ><\00 = SuGLJ z::,-"V 1"2.~", - ([ ,......J......c.~ I I :xtension Ext. Walls C.d Interior Finish ..5- ( 12-. i +-- :xtension Fire Place - H.eat /-1 /1. I I I Parch Roof Type Porch Rooms 1 st Floor I l reezeway Potio Raoms 2nd Floar I I ;arage i Driveway Dormer i ). B. I' I ;z. '3 sac:. . I . . J IJ -..J ; " I o I I I I I i i I I I I i I I I 1,-;( " .1 I i I , i I I I , I I i I I I I ., I I ! I I I 1 I , --. j i 'i(t> , I i I , 'H- i 1 ~ I i , I i ' "'TTT1 Ii! , !, /u!9o --=--===~=o- - ~==-~'-'~'--. ~.. \ -"~'I1::-~"'i" ,.. _ ~';'& \l.l '1-2" t_,<;.*> - --t;;,l.Sc... \..Jt:;L~ ';'i:>-- . i ~~ ~l(IOC 50 1'765 I I I i ; ----..:>.o...,~ ~~ \DO . TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Survey Check Septic F onn N.Y.S.D.E.C. Trustees Contact: PERMIT NO. .;2 BJ 01 &6 Examinedh./7 Approved ~. 17 Disapprove ale 20 0--.... '- 20 01- '- Mail to: Phone: O R (~ ~ ~ \11 IL ~ IS lJ ....-. \ - ,. . C\ UU "0 " L IllOG O\'?T. TOWN. Ol' 0 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 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 the premises 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 a Certificate of Occupancy is issued by the Building Inspector. leA TION FOR BUILDING PERMIT Date I//;)'() . ,2021- INSTRUCTIONS APPLICA nON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South old, 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. Fe II R f.sfa.- V rcmt rW~_. (Signature of applicant or name, if a corporation) ~lq5 /(prwih Blvd. 6-~p~ My! Inqq (Mailing address f applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder A- ~ )(ral1t i~ I~<;ep Name of owner of premises A---'1ih () it Y Pirref'f{ (as on the tax roll or latest deed) If applicant;.ra corporation,.?,-gnature of duly authorized officer Gf /!A",* + ~fj2 (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. w~\ vaC,5rJ- I. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No.1 000 Section Subdivision 5'5 Block 0 a Filed Map No. Lot ~Oll Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed cons a. Existing use and occupancy' GC U '::> b. Intended use and occupancy I h <;ettt le~ - /L((/)( tl~ fer II V'6f vtt Alteration X 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition Other Work (Description) 4. Estimated Cost 4/0) 000 Fee 5. If dwelling, number of dwelling units If garage, number of cars 6. Ifbusiness, commercial or mixed occupancy, specifY nature and extent of each type of use. I/) 1 /rJ CtJfhllJ e fir I'd / (to be paid on filing this application) Number of dwelling units on each floor 7. Dimensions of existing structures, if any: Front Height Number of Stories , . " ..Rear Depth i~ d P. ' P' .~.. , Depth Dimensions of same structure with alterations or additions: Front ;~" Numter Q:~~:.ories Rear ' '=.~.' I ., . Depth" Rear'l , Height 8. Dimensions of entire new construction: Front Height Number of Stories ~-~~.=JJ 9. Size oflot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 5 12. Does proposed construction violate any zoning law, ordinance or regulation: AI /) 13. Will lot be re-graded # 0 Will excess fill be removed fr?m premise~i YES. NO Pt\tc~c ~e M.lln ~, " 14. Names of Owner ofpremisesAtl~ ~o'ily P'TJ'{'rtl Address~ ~2J1, e, No. 63/ J(5'1 - 1.,/6 ~{, NameofArchitectJ\'l.:lrtl: K.~Wol"tz 04.1: A. Addres~IIP II '6neNcl~173it- o/IRS Name of Contractor Address . Pli.oneNo.. ' 15. Is this property within 100 feet of a tidal wetland? *YES NO · IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 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 .51 Efr:J1 {C ) F'(' II V).{\ Fe II being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the C6V' {)A M./..e off((~E> r ~ (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. Sworn to before me this / ~~~,~?~aL Notary Public 6J~AjL iJ~ Signature of Applicant SUSAN K TOOKER NOTARY PUBUC. Slate of New York No.01T05078120 Q~ali'ied in Suffolk County Commission Expires May q z.,i5l.J). . {h