HomeMy WebLinkAbout33398-Z Swimming PoolFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33200
Date: 08/07/08
THIS C~a(TIFIES that the building SWIRMING POOL
5ocatioa of Property: 61475 CR 48
(HOUSE NO.) (STREET) (HAMLET)
County TaxMap No. 473889 Section 45 Block 1 Lot 2.1
Subdivision
Filed Nap NO. -- Lot NO. __
GREENPORT
conforms substantially to the Application for Building Permit heretofore
filed i~ this office dated SEPTEMBER 14, 2007 purs~ant to ~hich
Building Per~/t NO. 33398-Z dated SEPTEMBER 14, 2007
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 INGROUND SWIPING POOL WITH FE/qCE TO CODE AS APPLIED FOR PER
ZBA # 4942, DATED 3/20/03.
The certificate is issued to BREEZY SOUND CORP
( OWNER )
of the aforesaid building.
SOFMOI~K COD~TY DEPARTM~TT OF IIEA~THAPPR~ SP06-016R3
m.~rI(/CALC~TIFICATENO. 8244
PL~P~ c~KTIFICATION DA'r~u N/A
0?/22/08
o5/13/o8
Rev. 1/81
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT J~Jk
TOWN HALL
765-1802 ~ ~'
APPLICATION 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).
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. Commemial 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 showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly corapleted application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Lnspector 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,
'
New Construction:
Location of Property:
Owner or Owners of Property: [ ~_~C22q:~c_~2~
Suffolk County Tax Map No 1000, Section
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 - $~25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date.
Old or Pre-existing Building:
House No. Street
(check one)
Block Lot
Hamlet
Subdivision
PermitNo. ~a::~ ~ DateofPermit.
Filed Map.
Applicant:
Lot:
Health Dept. Approval:
Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate
Final Certificate: L///'/' (check one)
Apblicant ~gn~t~e~'
Nassau Suffolk Electrical Inspections,Inc.
P.O. Box 549, Aquebogue, New York + 11931
Tel: 631-591-3097 Fax: 631-591-3098
Application: 8244 Date: 5/13/08
Issued to: Cliffside Resorts
Address: Rt. 48 Introduced By: Modern Electric East
Village: Greenport License #: 4253-E
Residential Commercial []
The following was examined and approved up to the above date and found to
be in compliance with the NEC:
Attic Ist Floor 2"'~ Floor 3r° Floor Garage Conversion
Basement Hot Tub Addition Detached Garage Pool
Switches I{eceptacle Fixlures G F I Emergency/Exit Emergency
Signs Liglltin~
2O 30 64 4 6 3
Fans 1 hind D~ycrs Washer/Amps Dryer/Amps Microwave Motion Sensors
3-Ex Bath 2 I [ I 2
Furnace ()il Gas I lot Water Heater Whirlpool Bell Transtbrmers
I )cs I-Gas
Rough Insp. II I'inal Insp Meier Amps Phase Motors
Other Equipment:
2-Time Clocks
I-Air Handler
I-3 Ton A/( Compressor
In Ground Pool: I -Sxx. I -Reccpticle,4-1'ixtmes. I - lime Clock, 1-2l Ip Motor. I-GFCI
Club House
This certificate must not be altered in any manner
88/81/2888 13:58 6318525871
COUNTY OF SUFFOLK
STEVE LEVY
SUFFO{.X COUNTY EXECUTIVE
DEPARTMENT OF HEALTH SERVICES
B~;;e; L, HN~PER, M.D., M.P.H.
~uly 22,2008
Jeffrey Butler, P.E.
PO Box 634
Shoreham, NY 11786
Subject: Swimming Pool Construction Approval
Breezy Sound aka Cliffsidc Resort, Greenport, Town of Southold
----SCDH$ Job # SPO6-016R3
SCDHS File Ref # 17731
Dear Mr. Butler,
This office is in receipt of the certification letter you submitted to this office indicating that the
above referenced pool facility was constructed according to approved plans, and the certificate
indicating that the pool is in compliance with the National Electrical Code. Based upon this
information, and the inspections conducted by this office, it has been determined that the facility
was constructed according to the approved plans.
Please be advised that an annual operating permit must be issued before pool operations may
begin. For more information about obtaining an operating permit, contact Thomas Nanos, Senior
Public Health Sanitarian, at (631) 854-2525.
Ir'you should have any questions in this matter, please fee! free to contact me at (63l) 854-2545.
Very Truly Yours,
Senior Public Health Engineer
cc: T. Nanos, SCDHS
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. 33398 Z
Date SEPTEMBER 14, 2007
Permission is hereby granted to:
for :
BREEZY SOUND CORP
PO BOX 815
QUOGUE,NY 11959
CONSTRUCT INGROUND SWIMMING POOL AS APPLIED FOR PER ZBA, PLANNING,
& SCHD APPROVAL FOR APPROVED MOTEL. THIS PERMIT REPLACES 32017.
at pre,bises located at 61475 CR 48 GREENPORT
County Tax Map No. 473889 Section 045 Block 0001 Lot No. 002.001
pursuant to application dated SEPTEMBER 14, 2007 and approved by the
Building Inspector to expire on MARCH 14, 2009.
Fee $ 200.00
ORIGINAL
Rev. 5/8/02
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)
NO. 3~7 Z Date MAY 18, 2006
PERMIT
Permission is hereby granted to:
SOUND CORP BREEZY
PO BOX 815
QUOGUE,NY 11959
for :
CONSTRUCTION OF AN IN-GROUND SWIMMING POOL AS APPLIED FOR PER ZBA,
PLANNING & SCHD APPROVAL FOR APPROVED MOTEL
at premises located at 61475 CR 48
County Tax Map No. 473889 Section 045
pursuant to application dated MAY
GREENPORT
Block 0001 Lot No. 002.001
17, 2006 and approved by the
Building Inspector to expire on NOVEMBER 18, 2007.
Fee $ 200.00
Authorized Signature
Rev. 5/8/02
ORIGINAL
~,~8/3o/2o05 14:4~ FAX 8313687748 LSM_DEVELOPMENT
APPEALS I:/OARD MEMBERS
003/014
Sou£hold Town Hall
5309.5 Main Road
P.O. Box 11'79
$outhol~ New York
ZBA Fax (631)
T~p~n~ (~1) 7~.1 ~9
hup:tl~cu~ol~rk,net
TOWN OF
Fl NDINGS. DELIB,~TiOk,~ AND DETER.I NATION
~N~3 OF ~,/~RCH 20, 2003
Soatho/d Tows Clerk
~l. No. 4942 - ~EEZY SO_I. JND CCC~c'.
Pre, carry Location: North Side of C.R. 48. a~kJa North Road (opposite San Simeon
N[~r=in9 Horde). Greenport; Parcel 1000~5-01.,2.1.
APt~UCANT'B REQUEST: Applicant is requesting a Special Exception under Bec. Lion
10t,~61B(4). for permission to estabash new 6~-unit motel with motel office, pool house
for motel guests, and mo~el-manageCs apartment unit as shown on the diroensionel plan
prepare~l by Barrett. Bonacci a~d VanWeela, P.C. dated 10/3/01, revised 8/2/02.
P~rtDPERTY FAc'rS/DESCRIPTION: 'l',-~e applice.~t's 7.13-ac;~ parcel is unknprovecl
and rs located on the north side of C.R, 48, a/'rJa North Road, in Greenport, and is
located in t~he Resort- Residential (RR) Zena D~s[tict.
FJ_I';DING~ 3F FACT
~'-a; Zenlng Board of Appeals held a ,~mbli,; hearing on this application on October 17,
2[?0?, and January 16, 2003, at which J~ ,¥3 written and oral evidence were presented.
Bt~.~ d upon all testimony, do¢.,roentetlo¢,, I~.monal ln.spectJon of ~he property, end other
av,~t'Jc~. [he Zd~ing t~oard finds the foJlcwlng facts to be true and relevant:
C~,~jE PROVISION Code ~ection 100-$ID(4) provides thai the following am permil;ted
by ~pecia[ ~,_.'eption approval from the Board et A~peats, subject [o site plan approval
by ~t~ Planning Board:
Transient hoeMa or m~al~, re. sort hotels or motel~ dc coni'arence ~ecilJaes.
~oltowing requirements are met:
(&) Mirgmum parcel size ah~ be Rye f.5) t~o~es.
(b) The mz~Jmum ~umb~r of gue.~t u!;lr.~ ~hall be:
[1] One (1) ui'~ gar six t~c'.{~Ja,'l(;I (6.000) square feet o! land wilhout publl~
[2J One (1) unit per ~,~: thou.larld (4,000) aquae feet of Jand with public water
{c) No rouelG, entertainment or 1OUc,~,~saker ~ystem shall be aud'~ja ~rom
b~yOl~l the ~0roper~ I~n6.
(dj The maximum size of a gu~ unit ~he~ be srx ~ndmd (600) ~uam ~
.,08/30/2005 14:40 FAX 8313897746 LSd_DEVELOPmENT
2an 13 04 0~ 18F:, I~oorm, La~
Pag~ 2 - ~ 20, ~
1000~t-2.1 at
631~;S4643
)
[~ 004/014
in addiUon, the Board has revieweO ~e Ge~3m'al Standarcls governing Special Exception
uses set forth in Section 100263 and finds that:
A. That the use v~ill r~3t prevent the orderly and reasonable use of adjacent properties or
of pmpe~es in adjeceot use districts,
E,. That tbs use will not pmwnt the orderly and reasonable use of permitted or legally
established uses in ~he district wherein the requested use is located or of permitted or
legally ealabltshed uses In adjacent use dis~cts.
C. That the safety, the health, the welfara, lhe c~fott, the convenience or the order of
the town will not be adversely a[fected by the Resort Motel use and its location.
D. That [he use will be in harmony with end promote the general purposes and intent cf
Un;s chapte[.
E. That the use will be compatible with its surroundings and wffh the character of the
i~eighbOrh~d and of the community'in general, particularly with regard to visibility, scale
~d ov~a# appearance.
F. That ell proposed s~ructums, equipment end material shall be readily accessible for
tim and police protection.
BOARD CONSIDERATIONS/REASONS: 'In considering this applice0on, and on the
basis of testimony ~esented. materiels submitted and per~3nal inspections, the Board
has reviewed the code requirements set forth puPsuant to Section 100-61B(4) and finds
that the applicant complies with the Code requirements, and that:
1. The proposed Reso~l. Motel is required to be built on a minimum el= five acres.
Breezy Sound Shores Corp. has sev~n acres located on County Route 48. The
~roposed project is bounded on the east by a rnot~l and a cO,'ldominfum, and on the
west by a motel. The $i1~ is located acr~ from the San Simeon Nursing Home on
County Route 48. end to the no~th of the site ~s a bluff overlooking Long I~land
Sound. Breezy Sound Shores Coq3. has received a Permit to build from the Town
Trustees amended 1/7/02,
The number of guest units is determined by the availebirr~y of water and sewer.
When both are available, eno unit per four thousand square ~eat ia allowed. The
applicant has permission from the SulYolk County Water Authority to hook up to
public water, Breezy Sound Shores Corp. alee has obleined approval f~r e
chromoglass system from the Suffolk County Board of Health for sewer disposal or
,o8/30/2005 14:4~ FAX 6318887745 L,~_D£VELOP~EHT
~en 13 ~40~?lap
r
~ga 3 - Ma~h 20. 2003 '
Appl. N~ 4942 - ~ ~und Sho~
1000-45-1-2.1 at
'3
~005/014
they are in negotiations with the Village of Greanport fo~ sewer hookup. This
allow construction of 68, units_
NO music, entertainment or loudspeaker ~yatem shell be audible from beyond the
property line.
'The maximum size of a guest un~ shal! be 600 square feel The applk:an{'s plans call
f3r a living ama. k[tchenelte, and two t3edmoms ,311 within the 600 square feel limit.
The definition of a Resort Motel a(~o includes the permission to build a manager's
unit with one bedroom and kitchen, and a pool house, pool, office, and beach
After considering all Items under Section 100-6~ B(4), no evidence has bee~ submitted to
show that [he ssi'ely, health,-welfar6 convenience order et the Town would be adversely
3ffected by this Resort Motel use. This project is subjac~ to a site plan review by the
~"annlng Board.
R[?,O, LLrTION OF THE BOARD: In cor]side~ing all et' the above factors and applying the
b.~;anc~ng *.est under New Yo~ Town L~W 2117.B, molJon was offem~l by biember Olive,
seconded by Member Tortom, and duly ce~;.~d, to
GRANT the applica~on far a Spactal Exception, for a Resort Motel, subject to the
following Covenants and Restrictions, to be prepared by a.oplicant in rec~_rdable
form, approved by the Tm~,n/~,ttorw~y's O~.ice, and filed by the owner/applicant
with the Suffolk County Cler~;'s '3m~a:
1. Regardless of I~e form of ~ww~rship of the Resort Motel or the individual
motel units, the resort motel will be operated in accordance wi~'l the Southold Town
C0~le. In accordance with the Southold Town Cede, the Resort Motel shall be "rented
on ~ daily renbal basis or for vacetionem Or ~[her persoi3s on a weeldy rental b~sis."
2. A Management Company, or equivalent, shall be established which will
manage the day to d~y'operatlon~ of th~. resort motel and shall monitor [hat ~he units are
ol;,urated as a resort motel, A Board of Managers, or equivalent, will establish the rules
~c regulatk3ns of the complex. ']'he ru~s ~nd regulations sha[I be in conforml[~ with the
S¢~L,thold TOwll COde,
3. The Operating ^gmement of ~is complex wil~ provide that Inalvldual owners
of t{~a resort motel units shell be guaranteed no n~ore than N/o weelcs of occopancy of
th~.ir uni~ auring the prime seaso~. The units am to be placed in a rental poet and
&v3~labla to the public. In the event th=~t the unit is not rented, the owner of the unit may
~8/30/2005 14:41 ~AX 6313887746 LS~4_DEVELOPt, IENT
~[&n 13 04. 02:~P ~oo~ Lam
Page 4 - Mmch 20,
A0pl. No. 4~2 - Bm~ Soun~
1~5.1-~1 ~
~006/014
then occupy the unit in accordance with Ihe rules and regulations established by the
Board of Managers.
4. The R~rt Motel will be closed from January 154 through March 154 of each
year.
~ 5. The units shall eot be occupied as a dwelling.
6. The Resort Motel unit shall be rented as a suite with two bedrooms, and the
bedrooms may not be
individually rented.
Trois aclJon does not aulY~orize or condone any c~rem or futura use, setback or other
feature of the subject property that may violate Ihs Zoning Coda. other than such uses,
se~acks and olher features as are expressly adciressed in this action.
vote of the Board: Ayes:. Members Tortora (Chaim/oman), Goeh~ngec, Orlando. and
~?va. [Al:~ent' was: IViember Homing or' Fishers Island.) ,,~is I~esolution was duly
~ ,opted (4-0). ~~F
Lydia iling
PLANNING BOARD MEMBERS
JERILY~T B. WOODHOUSE
Chair
KENNETH L. EDWARDS
MARTIN H. SIDOR
GEORGE D. SOLOMON
JOSEPH L. TOWNSEND
August1,2008
Patdcia Moore, Esq.
51020 Main Road
Southold, N.Y. 11952
MAILING ADDRESS:
P.O. Box 1179
Southold, NY 11971
OFFICE LOCATION:
Town Hall Annex
54375 State Route 25
(cor. Main Rd. & Youngs Ave.)
Southold, NY
Telephone: 631 765-1938
Fax: 631 765-3136
RE: Site Plan for Breezy Sound, Greenport
SCTM# 1000-045.00-01.00-002.000
Dear Ms. Moore:
The Planning Board is in receipt of your letter requesting a final inspection dated
May 28, 2008 for the above referenced application.
As you requested, a site inspection was performed on June 9, 2008 and June 20,
2008, and we found that the site work was incomplete. At a third site visit on July
2, 2008, the Planning Board determined that the site was developed in
accordance with the site plan approved on July 12, 2007.
Please note that Planning Board approval is required prior to any significant
changes to the site. Please contact the Planning Department with any questions
regarding the above matter.
Sincerely,
Kristy Winser
Senior Planner
cc: Building Department
Town Engineer
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
] FOUNDATION 1ST
[ ] ROUGH PLBG.
] FOUNDATION 2ND
] FRAMING / STRAPPING
] FIREPLACE & CHIMNEY
[ ] IN~fULATION
[ ~FINAL~
[ ] FIRE SAFETY INSPECTION
[
REMARKS:
] FIRE RESISTANT CONSTRUCTION
/
[ ] FIRE RESISTANT PEN,-i.ATION
/
DATE
INSPECTOR
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST
[ ]FOUNDATION 2ND
[ ]FRAMING / STRAPPING
[ ]FIREPLACE & CHIMNEY
[ ] ROUGH PLBG.
[/,,,}~FI NAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS:
DATE
INSPECTOR
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH FR_A/VIING &
PL~G
~S~ATION P~ N. Y.
STA~ E~RGY CODE
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/S outhold/
Examined ,20
Approved ~/7 ~, 20
d
BUILDING PEPdVI1T APPLICATION CHECKLIST
Do you have or ne~d thc following, before applyiag?
Contact:
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Mail to:
Disapproved a/c
"~ P, ~" ~~ ('~ ]~ · / Phone:
Expiration
~ ~ ~ APPliCaTION FOR BUILD~G PE~IT
~STRUCTIONS
,200_
a. This application MUST be completely filled in by typewriter or in ink and submitted to th~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, relationslfip 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 the Building Inspector
issues a Certificate of Ocoupancy.
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 fi.om 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. Thereatter, a new permit shall be required. '~ . .
APPLICATION IS HER_EBY MADE to the Bmldmg Dep~.[~fgr 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, ~r 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 premis6s and in building for necessary inspections.
(Signature of applicant or name, ifa corporation)
~:/.... (Mailing address of applicant)
$1- 36 q -t 0,5
State whether applicant is owner, lessee, agent, architect, engineer, g~eneral contractor, electrician, plumber or builder
Nameofownerofpremises'~ ~'~'Ot ~'X' 1[,"'--'~1~__ ~&.t~-___ ~r . .
I (As on ~e t~ roll or latest de~)
~ ~ ofco,orate ~ffi~ ~
Builders Liege No.
Plmbers Lic~se No.
Elec~ci~s License No.
Oth~ Trade's License No.
Location of land on which proposed work will be done:
House Number Street
Hamlet
County Tax Map No. 1000 Section
Subdivision
(Name)
Block
Filed Map No:
Lot
LOt
2. State existing use and occupancy of premises and int~aded4~se gnd 6eeupancy of proposed construction:
a. Existing use and occupancy C~,~-~.~_aO [.,~,~I~
4. Estimated Cost '~. ~ ~.~ ~- ·
5. If dwelling, number of dwelling units
If garage, number of cars
b. Intended use and occupancy "~:~o~' ~o"C
Nature of work (check which applicable): New Building ~ Addition
Repair Removal Demolition Other Work
Alteration
Fee
(Description)
(To be paid on filing this application)
. Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of.~dsting structures, if any: Front Rear Depth
Height~'X ~_.. Number of Stodes.
Dimensions of same-~,Z~J,u_re with alteratk~s or additions: Front Rear
~T'~ ~ Number of Stories
Depth He t...~3 ~
8. Dimensions of entire new construction,/Fro~.t.,.~ Rear Depth
Height N u ~n b e ¢'o'f~t~ie~.,..~
9. Size oflot: Front Rear &D~..~.~,~_~
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO /
13. Will lot be re-graded? YES ~O Will excess fill be removed from premises? YES__ NO
Xl~ es of Owner ofnremises'~-r~e,, ~-~-~,~, ~ddress~Phone No.
Name of Architect ~.~-~ 7"~,~,~a~ Address "~rr,~.,,e.~,,~ Phone No 5/- 7Z'? 7et~J'
Name ofContractorL~#/~l~¢~,t,~,P,q£aJ~' Address ~r~,.~,*-,t/-~ Phone No. ~
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES ~,'"~O __ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS ~AY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES ~ NO
* IF YES, D.E.C. PERMITS MP;Y BE REQUIRED. -- ~,
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on pr.operty is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK) "~,,,
SS:
cot rr¥
being duly sworn, deposes and sayl that (s~ is the applicant
(Name of individual signing contract) above named,
the ar-o
(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.
Swomlo before mc ~ f ~~,
/
U Not~y Public ~-~
Signature of Appall, ant