Loading...
HomeMy WebLinkAbout1741A WORKERY COMDENSATION�ECLARATION p�pp����q��pN FCyR PLUMBIIVG PERMIT � i I here6y affirm that 1 have a cerri{imfe of aonssnt�o sell �y��q insure,or pcMificye of Nyrk6K"�GoMpontCHM lnwronce, QBt�(qFv.ip.B�) . �( �, or o eert(H!d cepy tharoa!f5sic.39CQ 18b.C.) !(„Q�fJ�T'�I'�[i,�;G1S�NG.EI;ES B�11LDI�VG•�Cl� ��`.i4 p L q,;}��'� Po�I���b��S'.pmeam.F�rmm�r-f� 7r�Aamt1� ^j� . . . . _ - . faniUad coPY t�hereEy furelshed, � . .. . ..... . . . ,. '� -- - eu' oa , i � �CeniNad mpy la f(IAd wnhdhe mvnry bv. na InSPec- ..'iCilAPF17CAtIf70�.kINZ6AM/�1117Cb) , tiondepoitmnro. ��' -� ^� � � - w�E4ctUSE� i�� .. 3II1Qxlf� '�s3T Date �-/��Appll�tane ' . : . c�ren►aca�nv�. orrrtaCwa+n+�a�as• .Z, a.r�rue r �sr: 60 pk�.1�.3 s Ran�h ' �v�atvsuKncvte � owr� o " i (Thl�yectlonhNdno�6�hcOmPTifid�IPt�r�orkinrelvrdby �i � th�parml!U�for ort►hundt�d doUan jSfDO)or lin.� uvwlC7Rr qpp��s � i I certUq ihdt In 1Pp�perfofR�En[b ti/Ihb N+ork ftlr Whlth this . permU is issued.I shNl nar.OmP��Y�a�Y PI��in arry mMner J � att tEt. so as+e eeecn�ne�byenee+de WBtken'�ivnpeeuoron b�. p�y� — c�roRR.�',..R. FlumirEn IN�. Oa�e,.�_„_,,,,l�ppUeam . . ao1HRw�cvfEv — � ^�OTICE TO AORICJWi: H,rpfter mpMn{��hls�6r11tiW1s of �� � �mP��^. �Wo sh0old�btleam4 subjDn ro iho Werken' SwfdIFAiNG0001�04 CRY � � 'tg,.qp. . �j �..mGlnsPtlD�11�arislO�U O�lh�Il7���C�Ade,Y���fGAh- NM�RINKIFR SPSlFM � . .�. .� . w�th mmD�Y wuh wcn�rov�acns a ahb perm�+.r»rr be �"�,�. 33642$ c�iss .0 36 � dee�ned rencked. vrs.fHfH[afER — �i UCENSED�GC�I�DEC1:9itAt�ON � _ ois�crnro. rr�ssEvav �herohr off�m ehpr:�pm tIC ad u�f��i�roi Ch4pee.s cuaSxstE,v� arrL4rs D } � (cammencuq wuh Sacuon�p)41�Dt+�t�(pn 3 01 A+s Bunneas pypy and RoFessioru Cade,andary hcMffi 1s ia iail[beeeand�effxt �� � �FINAI 6 � u [innnoN o � onh !t//�'��`'l v ' License Nomber��.,,.tic-Flesf�p,�;,�_ FNAt 0 I v^.+v c�,��,«B,� -�s'I.tnnfrin�oms 6 f 1.Q l'8 S sr v : . ❑ I am e:empf unlx Sec. y j S B.BA.C.for�hi�raawn � Z �i pfpn zheCk f�:e oo�.: vuunne�Nc o�ttanir,Ssui�f4�s ^ Signoturo � t � 1 L;,� }� fOTAl FEE .(� �..�... r rj Glon chedc ePWfcCn� I • •�;��.�i� � SINGIE FAMI4Y - �i HOMEOWNER-6U�lAERDEC1AIfAT10N �Name A'+•,:�'i.}�• g�a��'�a��. �.f.'.� - ", ±reby of(irm�ha�i om�e�empr fiom ihp�pnmpnpra l�ronse �- .gno�-� a � ve, • •+��`�Ci� � ,�v for�he folluwing reosor�(Seenon 7a7�.5, Buunen and � 0 7.2 9-€3 5 � feuiam Cods?• L�ry � f61.N' � . ❑ 1,as owner of 1he prppeny,will dp the wprk ond�hs . � . � � snue+ure�a nat inrended or offered fa eals(Section � 704a,Bus�ress pnd Prnfesaiont Ceda). („dNSTRUC?IONYFNpING AGENCY I hereby offiml iho�rlwe b a conclwwc+ian lending fJpeney for � the performance of the work for which Ihfa paru�u i�issu�d I (Sec.309>.Cir.C.). � Lender a Name Lendu i qJdress � " �C �nnify fho�I hors read�h�s appl�m�ion and sApte ihN al�e a6we informouon�s cotran.1 O�roe to wmpiy w�ffi�pD Copnly � i ordinance�and Sro�s 1Dwa rngvMnqO Plurtibirry.and-heraby � aufhaiu repreeentaNKex d it+b Caunry ro-an}m upon ahe ,, above-mentioned p rry fa�rup tion ywAases. ; SEE REVF1tSB F�lt EXRIANATdRY�1;ANGUAG� pnoture o PenA�ee6 � r� � ' S310N S.2i01�3dSNl �aurnp �104 .. uosoai si4�a°}'yd'8 9 • ����apun�dwaxa w�� (�o�os�o esod�nd ey��o�oeoldwi�o ppnq iou pip ey�oy�6u�eo�dlo wp�nq ay;enoy��rn��aplinq-lau.s�o � ay�•uo��a�dwo��o�oaA euo u�yqna p�os st�uawanoxlw� � � .io 6ulp��nq ey�•�anamoy���•o�oc�o�pa�a��o�o papua{u� , �ou a�o s�uawano�dw�y�ne�oyl papl^o�d j�asw�y��om . . y�ns zoop oym pua •uoe�ay� s�noadwl �o sp��nq oym � � � � � A�•-ao�d yo�au,wo uo o�6�ddo�ou srop n�a�asua���s�o� � � � �. . � � � � . o)ayt :apo)suo�scafo�dpuossau�sn9'YYOL'�aS) � •- •a�os�o�paia}yo�o papu3�ui�ou si oin��n�is ayi - . 1tlAOZJdH 31St'�.1 puo'��am oy�op���^n 6�iado�d oy�;o�aumo so'�� 1VIe15f1�N1 ' �'�0055)s�o��oP �, polpuny ani� uoy�n�ow�ou/o A��OUa[I��ni�D o��uo� . -qCdo ay�si�alqns i�w�ed ovo�iva�qddo.too 6q S'lEOG �uo�{- u�.r�u� � 1NN,� �' u � vo���aS �o vo��o�o�n Auy �uo��divaxa pa6ago ay� �o� . . • � siscq ay�puo wa�fa�aya�dwoxa s�ay�nya�o(apo�sua�s - -so�o�d pua ssa�isng ay��o r uo�surd�o(ppp�uo��oag 431�I1ON'O�.LLI111f1 , y�!m EUPuawwo�)d�a�doy))mo�esua�i7 s�opo�{uo� /') 1S31SV`J uy��c suoi:�no�dey{o��uons�ndposua�q s�oy�oy��uaw , - 53�f11xli JNI:Vlfiki ' -�Iws pau8�s o a�y�o�!lw�ad yonvo}/+�o���ddo ay/w�lnb � � � -o�05�0 '3JpDO551 5�I o��oyd •a�ni�n��s.Suo�iod���o , a3Ltl3H 8317M lOH �ysi�owop�anoidwi•�a��o�pn»suo�o�yw�od o sa��nba� i 1h3�Sv� � �p�ym.qunc��0 6�n Auy:(apo)suoissa�osd puo uourmg - �Nldld Sv9 'SYLOL uoipag) msoai 6wmo��o� oy� in� mo� osua�i� '�f Q/ '�wBWf11dH°Jf108 � s ioi�oiiuo�ay�.wo�}l�'woxa wo��oy�w�iy}o Aqaioy � _ � ��y� , . , '^4'� � /%� ��OM9b'1SL'3�Nf1 NOI1V��11�3a 213411f1fl-L'?Nh10 S310N S.80ll3dSN� aauvN�is s.aoi»asnn 31Va S7VA02MdV