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Home My WebLink About93-48P Olivieri Accessory Apartment (5) 1R TOWN OF SOUTH WINDSOR, CONNECTICUT PLANNING AND ZONING COMMISSION APPLICATION FORM Application No. OR' - qV Date Received: Prr: Action/Public Hearing by: "Y Yyy: niern Yk. r w iY Receipt No . . <4 T APPLICANT: O N 96Z Q ' ADDRESS: LrJ S J Z) �& 2 ►� � J Planning &tl Windsor OWNER OF RECORD ON LAND RECORDS: � C (� 91 € —n 439 6vmilliYSIO0 ADDRESS: COMPLETE LOCATION OF PROPERTY: yo ASSESS S MAP# PARCEL# , 6 LOT# ZONE NAME, ADDRESS, & TELEPHONE NUMBER OF PERSON TO WHOM INQUIRIES SHOULD BE DIRECTED: 0( n r—CL l Q 0 L1 TELEPHONE: 6 6 THIS APPLICATION IS FOR: (Check all that apply) : 1 . Zone Change to (Public Hearing required) . 2 . Subdivision/Resubdivision. a . Subdivision Minor Major b. Resubdivision — Minor Major (Public Hearing Req. ) C. Conditional Approval d. Open Space Subdivision (Public Hearing Required) l �j 3 . Special Exception to Article (Public Hearing Required) 4 . Site Plan of Development. 5 . General Plan of Development. 6 . Earth Filling [Sec. 10] and/or Earth Removal [Sec . 9 ] (PH Req. ) 7 . Regulation Amendment: Zoning Subdivision 8 . Amendment to Town Plan. 9 . Temporary and Conditional permit. 10 . Other (explain in detail) : e C._CS S Q&X„ CONSULT PLANNING DEPARTMENT FOR FEE SCHEDULE. THIS APPLICATION MUST BE SIGNED BY THE APPLICANT AND OWNER OF THE PROPERTY AND SUBMITTED IN TRIPLICATE WITH ALL MAPS AND DOCUMENTS REQUIRED ON ATTACHED CHECKLIST, ALL OF WHICH CONSTITUTE THE APPLICATION. App ant e�r ,�/v nz� o 6 c/1,/ZF PLANNING AND ZONING COMMISSION APPLICATION, CONT'D. TIME FRAMES AND PROCEDURES FOR SUBMITTING APPLICATIONS/PLANS 1 . All prospective applicants are urged to confer with Town Planning. Department and Engineering Department staff prior to submission of any application to the Commission. 2 . Plans are officially received only on the fourth Tuesday of each month at the Regular Meeting of the Planning & Zoning Commission (PZC) . 3 . Three ( 3 ) sets of blueprints are required on the second Tuesday of the month for review by the Town Planning and Engineering Departments . This deadline must be met if you want to ensure that your application is officially received by PZC. . These plans must be submitted as complete plans -- which includes application plus all required information contained on checklist. It is the applicant's responsibility to ensure that all information required on the checklist is submitted in one package at the time of submission -- including landscaping plans, architectural elevations, traffic report, etc. 4 . After review, Town staff will notify the applicant of requested/required modifications . 5 . If the applicant makes recommended modifications to plans, six sets of revised plans must be submitted. If a Public Hearing is required (or optional but likely) then seven sets are required. Revised plans should be complete packages (applicant may disassemble previously submitted plans and reuse sheets if so desired) . 1 APPLICATION FOR PERMIT TO DO ELECTRICAI. WORK. No. ..........9.0.1,.4.............. _. Permit No. ..........79.03................... TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. �......... hereby make application tq perform Electr cal Work according to detailed description below. All provisions of the Rules for Electrical Installation, Section 48, Building By-Laws, shall be complied with whether specified herein or not. South Windsor, Conn., i ...a3... . ..... .. 10- Sign here p / Address �c1.. ... ..._S.i ............ C� .. Location ..........r�.. .................._._.._.... Side o1 Natureof Building .......... .. (�.__ .. ....................................__ How many stories .................a......................................................... ................. New or old Building ................v... ......................................... ....... .. How many families ................I. Kindof Installation .......L'...lt R.r ..............._.............................__..__ How many Stores ........................................................................................._........... Owner Address I..U.....L,.............. _......._........._...__...... Architect ............................. ... Addressr4.C!TJ........... : Builder ....... ............._................................. .......__.................................... ............. .. Address ............ ........................................................... _._._. Y ...... Electrician �-. . �-...r.�..._..�'�C........................... Address /..[..;3........ -------- Size of Main Wires ...-Zif.Q......................................... No. of Light Loops .........._1........._ ........ No. of Heat Loops .............. ..._._.. No. of Power Loops ........................._._...._.... No. of Light Outlets ....... ........ No. of Heat Outlets ....._._......__._.__..___. No. of Power Outlets ..................................... Nod of Light Circuits ........��.... ................ No. of Heat Circuits ...._.. ....._._.... . ..... .. No. of Power Circuits ............... ......... No. of Sockets ......................... ... ............ No. of Heat Receptacles .. __. ._ _ __ No. of Motors ................................................ .... No. of Panels .......................I................................ Size of Heat Circuit .__............. .. ... .. No. of Power Receptacles ..._ . ............. No. of Switches .......... .. .......................... Total Wattage Size of Power Circuit ................ . . .... . ............... Total Horsepower ............. .............. .......... . No. of Straight Electric Fixtures ........................................................... No. of Combination Fixtures .............._................................ .... ......... No. of Receptacles ............&.)._...................................................... ................. No. of Cord Drops ............................................................................................... Remarks: For other kind of Installation ...... `Z ...................... cnl......�5�, .... .................... ..................................T.—C t..............�6Z.c.L,X o.......-.....................a.....:..... 1.9 r........... /...c...-. � �+.^ -�._..�...... ...........__ .. ..............................................................................................................................................................._............................................................................................................................................ ............ . .............................................................................................................................................._.............................................................................................................................................................................. Estimated Cost ..Jr.r...v.�1.......................................... TO THE BUILDING INSPECTOR of d,e APPLICATION FOR TOWN OF SOUTH W MSOK COW PLAN EXAMINATION ANy BUILDING PERMIT M1 IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O • AT (LOCATION) /0�D �//��r'V' ZONING DISTRICT_ LOCATION (NO.) (STREET) DF BETWEEN �L�S .R�`�C) AND /'��ltiC_C �. G BUILDING (CROSS STREET) (CROSS STREET) LOT r�1, --/ + s SUBDIVISION LOT BLOCK SIZE N II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use fr m 1 ❑ New building Residential Nonresidential 20 Addition(If residential, enter number 12 RI One family 18 ❑ Amusement, recreational of new housing units added, i/any, 13 ❑ Two or more family — Enter 19❑ Church, other religious VI in Past D, 13) � number of units— — — — ••i 20❑ Industrial 3 Z] Alteration (See 2 above) 14 ❑ Transient hotel, motel, 21 ❑ Parking garage 4❑ Repair, replacement or dormitory — Enter number 5❑ Wrecking (If multifamily residential, of units ——————— — -i 22 ❑ Service station, repair garage enter number of units in building in 15 0 Garage 23 ❑ Hospital, institutional Part D, 13) ❑ 16 Carport 24❑ Office, bank, professional 6 ❑ Moving (relocation) 17❑ Other — Specify 25 ❑ Public utility 7 ❑ Foundation only Tj 1 26❑ School, library, other educational �\J B. OWNERSHIP 27❑ Stores, mercantile 8 X Private (individual, corporation, 28 ❑ Tanks, towers nonprofit institution, etc.) 29❑ Other — Specify 9 ❑ Public(Federal, State, or local government) C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement,,,,,,,,,,,,,,,, school, secondary school, college, parochial school, parking garage for, department store, rental office building, office building at industrial plant. To be installed but not included If use of existing building is being changed, enter proposed use. in the above cost a. Electrical..................... ttta Zhu ek[szi't �S Otii e - b. Plumbing ..................... 1 1 a�•... 1,. 1^a S-I cLfi x c e c. Heating, air conditioning......... d. Other(elevator, etc.)............ 11. TOTAL COST OF IMPROVEMENT E O III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; for wrecking, complete only Part J, for all others skip to IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30❑Masonry (wall bearing) 40,® Public or private company 48• Number of stories................ GND 31 Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area, c, all floors, based on exterior 32❑ Structural steel dimensions ..................... �Op 33❑ Reinforced concrete H. TYPE OF WATER SUPPLY 34❑ Other — Specify 42❑ Public or private company 50. Total land area, sq. ft. ........... 43;K Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... 2 35❑ Gas Will there be central air 52. Outdoors........................ 36® Oil Condit1oning? L. RESIDENTIAL BUILDINGS ONLY 37❑ Electricity 44❑ Yes 45® No 53. Number of bedrooms.............. 38❑ Coal 39❑ Other— Specify Will there be on elevator? 54. Number of Full.......... 46❑ Yes 47 E,No bathrooms Partial........ — t CCrj' ram` e A N COoP 1CLA 0 101 Si 2 bXk�f 55 - 21 . . Po oa f { - i j P I$ 3� { fY L NX e fi l Min i Onofrio Oliveri PH 12/13/93 1 . Application for an acessory apartment under 4 . 7 of the zoning regulations for property located at 1010 Strong Road, RR zone. Tho applicant has an existing apartment which was created sometine in the 1980 's . The applicant is requesting to make it an accessory apartment. 2 . The criteria which must be met include: the apartment can not exceed 700 sq ft- this apartment is approx. 572 sq ft. 3 . The applicant has provided pictures of the house from the front and rear and also a picture of the inside of the apartment. The main house was built around 1965 . A single- family appearance has been maintained. There is private well and town sewers . The applicant should be aware that the owner must occupy one of the two dwelling units at all times . 3 . It appears that the driveway can accomodate the three cars required in the regulations . Our maps indicate that there aren't any accessory apartments within 1000 feet of this house. The planning department has no further modifications to request, and there are no engineering comments on this application. y 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CONN. 06074 Solt-co�� AREA CODE 203/644-2511 December 16 , 1993 CERTIFIED MAIL Onofrio Olivieri 1010 Strong Road South Windsor, CT 06074 Dear Mr. Olivieri : Re: Application #93-48P, Accessory Apartment Please be advised that the Planning and Zoning Commission, at its meeting on December 14 , 1993, approved application #93-48P - Special Exception to Article 4 . 7 for an accessory apartment on property located at 1010 Strong Road, RR zone as shown on plans submitted. The condition of this approval is that the owner(s ) of the property must reside in the apartment or the main house. Reaffirmation of occupancy by owner will be required every two years . This will be done by a letter from the Planning Department requesting the reaffirmation of occupancy. The enclosed Special Exception form must be completed and filed in the Town Clerk' s office. The special exception will take effect upon filing. Very truly yours, PLANNING & ZONING COMMISSION arshall Montana Secretary MM/pmm Enclosure cc: Town Engineer Building Department Zoning/Wetlands Enforcement Officer Assessor Fire Marshall Registrars I , Marshall Montana, Secretary of the South Windsor Planning & Zoning Commission, hereby certify that on December 14 , 1993 the Planning and Zoning Commission granted to Onofrio L. and Elena Olivieri a Special Exception to Article 4 . 7 of the Zoning Regulations to create an accessory apartment, 572 sq ft in size (maximum 700 sq ft) . Assessor' s Map and Parcel Number: Map #88, Parcel #16 Address : 1010 Strong Road, South Windsor, CT 06074 More particularly bounded and described as follows : (legal description from Deed or Mortgage) by land now or formerly of Byron E West, one hundred fifty two and sixty four one-hundredths (152.64) feet; by land now or formerly of Raymond S. Holcombe, Jr, three hundred sixty four and eighty one-hundredth (364.8U) feet; by Strong Road, one hundred fifty two and eighty eight one-hundredths (152.88) feet; and by land now or formerly of Gardner W. Moulton, et al, .three hundred sixty three and six-tenths(363. 6 feet; OWNER OF RECORD: Onofrio L. Olivieri and Elena Olivieri Dated at South Windsor, Connecticut this 16th day of December, 1993 In accordance with CGS Section 8-3d Marshall Montana, Secretary Planning & Zoning Commission Received for record this day of 19 at South Windsor, Connecticut. ATTEST: Town Clerk �towM aF,`� y -Tow;n ale s-outA V&U&Ot o 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CONN. 06074 soe•ca AREA CODE 203/644-2511 November 23 , 1993 Onofrio Olivieri 1010 Strong Road South Windsor, CT 06074 Dear Mr. Olivieri : Re: Application 193-48P - Accessory Apartment Please be advised that the public hearing in the above matter has been scheduled for Tuesday, December 14 , 1993 at 8 : 00 p.m. in the Council Chambers of the South Windsor Town Hall, 1540 Sullivan Avenue. One sign, advertising the hearing, must be posted on the property for 10 consecutive days prior to the hearing, and must be clearly visible from the road. Please have one sign posted at 1010 Strong Road by Friday, December 3 , 1993 . Signs can be purchased in the Town Hall for $5 . 00 each . er truly yours , Phyl is M. Mann Recording Secretary Planning & Zoning Commission " SENDER: o I also wish to receive the I a • Complete items 1 and/or 2 for additional services. • Complete items 3,and 4a&b. following services (for an extra m I • Print your name and address on the reverse of this form so that we can fee): m return this card to you. O 1 > • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address y m does not permit. G 1 = • Write"Return Receipt Requested"on 0-ilpiece below the article number. 2. ❑ Restricted Delivery •m I • The Return Receipt will show to whom the article was delivered and the date c delivered. Consult postmaster for fee. o { 3. Article Addressed to: 4a. Article Number c 1 : P 389 188 815 4b. Service Type ilo ❑ Registered ❑ Insureo �° ONOFRIO OLIVIERI j6C � Certified ❑ COD W 1010 STRONG ROAD Express Mail ❑ Return Receipt for 3 MerchandiseSOUTH WINDSOR CT74 Date of Delivery At >. ( CCCC 5. Signs re (Addressee) Addressee's Address(Only if requested Y I H and fee is paid) w I W F I W 6. Signature (Agent) 1 0 I PS Form 11, December 1991 * U.S.G.P.O.:1992-307-530 DOMESTIC RETURN RECEIPT I — UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT U.S.MAIL OF POSTAGE, $300 Print your name, address and ZIP Code here 93-48P • PZC - TOWN OF SOUTH WINDSOR • 1540 SULLIVAN AVENUE SOUTH WINDSOR CT 06074 °'''�`�i`� L�• �'�'c�'�-�-TOWN CLERK DEC 15 1993 LEGAL NOTICE TO BE PUBLISHED IN THE JOURNAL INQUIRER TUESDAY, DECEMBER 21 , 1993 SOUTH WINDSOR - PLANNING & ZONING COMMISSION At its December 14 , 1993 Regular Meeting, the Commission voted to take the following action: 1 . Approve appl . #93-48P, Onofrio Olivieri - Special Exception to Article 4 . 7 of the Zoning Regulations to create an accessory apartment at 1010 Strong Road, RR zone 2 . Approve with modifications appl . #93-49P, J. E. Shepard Company - Resubdivision of property on the westerly side of Bidwell Road, I zone 3 . Approve appl . #93-50P, Susan Rubin - Special Exception to Article 5 . 1 . 2 . 9 . 1 of the Zoning Regulations to allow a day care center at 491 Buckland Road, RC zone 4 . Approve settings/reductions/callings of certain bonds Marshall Montana, Secretary i o SENDER: I also wish to receive the } 'a • Complete items 1 and/or 2 for additional services. following services (for an extra • • Complete items 3,and 4a&b. ,$ i • Print your name and address on the reverse of this form so that we can fee): ' return this card to you. > ❑ Add CA • Attach this form to the front of the mailpiece,or on the back if space 1. Addressee's Address does not permit. r, m • Write"Return Receipt Requested"on the mail il low the article number. 2. ❑ Restricted Delivery r • The Return Receipt will show to who the'4rticl� ered and the date Consult postmaster for fee. C delivered. o * 4a. Article Number 0 3. Article Addressed to: s' P 389 188 861 E ► r! 4b. Service Type I ONO>~RIO OLIVIERI ❑ Registered ❑ Insured j �artilied ❑ COD 5 I N 1010 STRONG ROAD �Cc Return Receipt for 1 W SOUTH yVINDSOR CT 60& ,k ❑ Express Mail ❑ Merchandise c I p ` 7. Date of Delivery 5. Si net (Addressee) 8. Addressee's Address(Only if requested w p and fee is paid) a H W 9! 6. Signature (Agent) f o I PS Form 3 11, December 1991 U.S.G.P.O.:1992-307-530 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE,$300 Print your name, address and ZIP Code here PZC - TOWN OF SOUTH WINDSOR 93-48P 1540 SULLIVAN AVENUE SOUTH WINDSOR CT 06074 I/we hereby verify that I/we are the record owner(s) of the above-referenced residence, and I/we reside in either the main dwelling unit or the accessory apartment. Name (please print) {}t� Q F R,\ U 2-C N 4 O L I V I G R.I Signature/ l ,J W-1 <0W N St,< o 9 1540 SULLIVAN AVENUE • SOUTH WINDSOR. CONN. 06074 AREA CODE 203 644-2511 OSOR COS June 2, 1995 Onofrio Olivieri 1010 Strong Road South Windsor, CT 06074 Dear Mr. Olivieri: Re: Verification of Owner Occupancy, Accessory Apartment at 1010 Strong Road In accordance with Section 4.7.4 of the South Windsor Zoning Regulations, owners of a residence that contains an accessory apartment approved by the Planning and Zoning Commission must reaffirm biannually to the Commission that one of the dwelling units is occupied by an owner of the property. Please complete the bottom portion of this letter and return the letter to the Planning Department, South Windsor Town Hall, 1540 Sullivan Avenue, by July 31, 1995. Thank you for your assistance. Very truly yours, Marcia A. Banach, AICP j Director of Planning MAB/pmm I/we hereby verify that I/we are the record owner(s) of the above-referenced residence, and I/we reside in either the main dwelling unit or the accessory apartment. Name (please print) Signature <0W N Sf44 o - Town 0-Yesar&A V11riulAot m 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CONN. 06074 4f �t ��SOR•GON AREA CODE 860/644-2511 July 24, 1997 Robert 8s Mangene Forrest 1010 Strong Road South Windsor, CT 06074 Dear Mr. 8v Mrs. Forrest: Re: Verification of Owner Occupancy, Accessory Apartment at 1010 Strong Road In accordance with Section 4.7.4 of the South Windsor Zoning Regulations, owners of a residence that contains an accessory apartment approved by the Planning and Zoning Commission must reaffirm biannually to the Commission that one of the dwelling units is occupied by an owner of the property. Please complete the bottom portion of this letter and return the letter to the Planning Department, South Windsor Town Hall, 1540 Sullivan Avenue, by August 24, 1997. Thank you for your assistance. Very truly yours, Marcia A. Banach, AICP Director of Plannine MAB/pmm I/we hereby verify that I/we are the record owner(s) of the above-referenced residence, And I/we reside in either the main dwelling unit or the accessory apartment. Name lease r -p t` Co r r e S (P Pint) Signature 1OW N SE4 C � J `own op S-outA `V C U m fi 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CONN. 06074 4f�dsox co� AREA CODE 860/644-2511 May 29, 1998 RECEIVED Robert 8s Mangene Forrest JUN 10 1"8 1010 Strong Road South Windsor, CT 06074 SOUTH WINDSOR PLANNING DEPT. Dear Mr. 8v Mrs. Forrest: Re: Verification of Owner Occupancy, Accessory Apartment at 1010 Strong Road In accordance with Section 4.7.4 of the South Windsor Zoning Regulations, owners of a residence that contains an accessory apartment approved by the Planning and Zoning Commission must reaffirm biannually to the Commission that one of the dwelling units is occupied by an owner of the property. Please complete the bottom portion of this letter and return the letter to the Planning Department, South Windsor Town Hall, 1540 Sullivan Avenue, by August 24, 1998. Thank you for your assistance. Very truly yours, a Marcia A. Banach, AICP Director of Planning MF B/pmm I/we hereby verify that I/we are the record owner(s) of the above-referenced residence, And I/we reside in either the main dwelling unit or the accessory apartment. Name (please print) v rr-e 4— Signature I/we hereby verify that Uwe are the record owner(s) of the above-referenced residence, And I/we reside in either the main dwelling unit or the accessory apartment. Name (please pri p . Signatur own sf"4� co O-Pso� ?d 1540 SULLIVAN AVENUE - SOUTH WINDSOR, CONN. 06074 9 AREA CODE 860 / 644-2511 �SOR-CO June 8, 2000 Robert&Mangene Forrest 1010 Strong Rd. South Windsor, CT 06074 Dear Mr. & Mrs. Forrest: Re: Verification of Owner Occupancy, Accessory Apartment at 1010 Strong Rd. In accordance with Section 4.7.4 of the South Windsor Zoning Regulations, owners of a residence that contains an accessory apartment approved by the Planning and Zoning Commission must reaffirm biannually to the Commission that one of the dwelling units is occupied by an owner of the property. Please complete the bottom portion of this letter and return the letter to the Planning Department, South Windsor Town Hall, 1540 Sullivan Avenue,by June 29, 2000. Thank you for your assistance. Very truly yours, ll 4X / Marcia A. Banach, AICP Director of Planning MAB/dlw I/we hereby verify that Uwe are the record owner(s)of the above-referenced residence, And I/we reside in either the main dwelling unit or the accessory apartment. Name(please print) Signature 9? h1tr CAROL M. MOUIT01'� \\ [YOL_uME ►47 PAGE ►�3� at G co d 2y' 15'00"K' qi SHED PROPOSED 004CRVM D OVER POLL. 6RSTLMF:N"r \ PER '9' (Tsokspe.F1.C,,EV.*43.5' / AL Ck 0. LOT r. rvoL.uME. 140 F PROPOSED z"o s' 9,Y AREA s 115 O ADDITIOR VORMEU BY �'ok F.KC KSIrIG WAL ;. Y ofcx- 0 4- 1- o- •9 / �q� O Cb PROPOSED 2 S'FbRY / �' Or ADDMOK OYEiZ r a • / FULL BP►sEMEKY d7 c...---. - _; �— S 2J4 13' OO"Ind 1.OY Q SOW N Se C� O T-0� olle Sou� ?d&U&01t C � a 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 f�OSox•co TELEPHONE (860) 644 2511 RECEiVEL August 25, 2016 AUG 2 92016 Mr. & Mrs. Bruce Tully 1010 Strong Road SOUTH WINDSOR PLANNING Dl�„ South Windsor CT 06074 Re: Verification of Owner Occupancy, Accessory Apartment at 1010 Strong Road Dear Mr. & Mrs. Tully: In accordance with Section 7.1 .5 of the South Windsor Zoning Regulations, owners of a residence that contains an accessory apartment approved by the Planning and Zoning Commission must reaffirm every 4 years to the Commission that one of the dwelling units is occupied by an owner of the property. Please complete the bottom portio of this letter and return it to the Planning Department, South Windsor Town Hall, 1540 Sullivan Avenue. Thank you. Sincerely, Michele Lipe, AICP Director of Planning Is the accessory apartment currently in use? Yes No No, it has been removed I /we hereby verify that I/we are the record owner(s) of the above- referenced residence, and I/we reside in either the main dwelling unit or the accessory apartment. Name (please print) Signature Date -�`�'l '