HomeMy WebLinkAbout6660-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No...Zl/0496 ........ Date ... March' '24} ................... 19 .g.1
THIS CERTIFIES that the building ................................................
Locat!~0n of Property ~ ~o5.90..P. lum. Iala~d .L-n.e ~'tr~i .... aP. ion.t, ~. II,X, ....
County Tax Map No. 1000 Section .01 fi ........ Block .... 0.4 ......... Lot... 0.1.6t ..........
Sub~ivisi0n. - .0~'i~nt~. t1~ .Ihs .Ssa. ~qe¢,t. Ffled Map No3444 ..... Lot No..1.111
conforms substantially to the Application for Building Permit heretofore Fried in this office dated
· ?'. J~ne..13 ~ ......... ,197.3. pursuant to which Buildin8 Permit No...6.6.6.0...g .............
o ated · · · ~}un*' '1'3 i ............... 197.3 ., 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 .........
· -.~'tvate One-F.&mit~ .gwe.l. liag. ....................................
The certificate is issued to ...... Qeer.~e. ,S ~e,~ ~'oe .....................................
of the aforesaid building.
Suffolk County Department of Health Approval ...... ~t-~$0.*..59.3].g~/'~.1..3 [i~.~./.Q .1..ll.q .b.~.l'.~.
UNDERWRITERS CERTIFICATE NO .... · · ~5117,%3 ...................................
Building Inspector
1/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
Ao
This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1 .{30
New Building .. y.~..~. ..... Old or Pre-existing Building ............ Vacant Land .............
Location of Property .~'~....~.~. · ·/~.~. ~ .~~. · .~ .... ~ /' ~ ~ ~'~
Hou~ No. St~t Hamlet
Owner or Owners of Prope~ .~~ · .~ ~. ~ ~'~ ..........................
C~nWT~MapNo. 10~Section ..~.0~¢.~.[~., Block ...~.~ .... ... Lot..~.~l~..
Subdivision a~T ~ ~' ~ ~;~ap NO ~'~ Lot No. .....
Permit No ........... Date of Permit .......... ~licant ..................................
Health Dept. Approval , ,~.. ,~ .... ~ ,~ ........ Labor Dept, Approval .......................
Unde~riters Approval ........................ Planning Board Approval ......................
~u~ for T~m~ora~ C~ifie~ ..................... Final C~ifioate ......................
Fee Submitt~ $... ~., ......................
Construction on above described building and permit meets all applicable codes and regulations. ,l q
FORM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Ne 6660 Z
Permission is hereby granted to:
...... ~l~i,m..~etlee~ .....................................
.......... · Be~th-.lte~ori-.~...Ave ..........................
~o .~.~llll..~m.~...o~a..£a~Ll~...d~e~lin~ .....................................................................................
at premises located at ..... lofa..lOl.....~a~.tant...b~..the..lle~..~ee..l.t .......................................
.......................... .R~ler...F&x~.. Ro~..&. i~tm --t el.~-..La ............... 9~.ient~ ...........................
pursuant to application dated ........................~ltlll~.....9~.~. ........... , 19.~.~.., and approved by the
Building Inspector.
Fee $..~9e1~0 ...........
' ~ Building Inspector
THE NEW YORK BOARD OF FIRE UNDERWRITERS
I~ BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK, NEW YORK 10038
o. te Ysaz'ch 5, 1981 ~pplico.on No. o./ile 0~331 - 79 N 5 1 1 7 5 3
THIS CE~IFIES THAT
~ S~s, PI~ la~d ~., ~ of ~ ~., ~t, N.Y.
in the followin~ location; ~Baze~ent ~ 1st FI. ~ 2nd FL Section Bilk ~t
was examlned on ~ 2 ~ 1~ and found to be in compliance with the requirements of this Board.
RXTURE
OUTLETS ECEPTACLES
SWITCHES
BXTURES RANGES OVENS DISHWASHERS EXHAUST FANS
FLUORESCENT
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATEE
MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
OTHER APPARATUS=
p~elboard/a: 1-16 cir. 125 ~-~.'.s.
1-~ ~etec r~
1-4.§ I<~, H.~.H.
NO. Of CC, COND,
1
OF CC. CO~D.
1/0
NO. OF Hi LEG
OF HI-LEG
NEUTRAL
1/o
George SCav~$,
132-26 Booth
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
FORI~! NO. 5
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
Dote December 19
.............. ~ ....................................... , ~9....8..o..
TO Mr. George Stavros .
(owner or authorized agent of owner)
5LI--f7 Roosevelt Ave. Woodmide t~Z
(address of owner or authorized agent of owner)
377
PLEASE TAKE NOTICE there exists a violation of:
Zoning OrdinAnce .... ,A, R. ?..:,,, ,X..~...~' .....................
Other Applicable Laws, Ordinances'or Regulations ............................................
at premises hereinafter described in that ......... ..~...q~..1..d..i...n.g...~.e....z~...$.~...~. ~.~..O. ......................
(state character of violation)
dated 1 has ex ·
................... 6./....3Z7.3. .......................... a .t..r.e..~..........Z..o. ~ ....a.r..e....r..e..%~,r..e.~....t .~... ~.~,. ~ ~ ~..a .....
new permit.
in violation of Sec. 100-1,.41H
(State section or paragraph of applicable law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the
conditions above mentioned forthwith on or before the .... .?.~.:5-..'9..~. ............
day. of ....~'..~...~.~..~.L~. ................................. , 19..~.?...
The premises to which this ORDER TO REMEDY VIOLATION refers are situated ct
..~.~Q..,.~...Z.~ .I~and Lane & !~.6g . County of Suffolk, New York.
Ryder Far'~"~.,~';"'5'~"~'~:~';' ~ ""~1"~'~7 -
Failure to remedy th~ conditions aforesaid and to comply with the applicable provisions of law
may constitute an offense punishable by fine or imprisonment or both.
Building Inspector
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, N. Y. 11971
TEL. 765-1802
January 9, 1981
George Stavros
~4-17 Roosevelt Ave.
Woodside, N.Y. 11377
Re: Zoning Violation
Dear Mr. Stavros:
As a follow up of the inspection made of your
home in Orient, N.Y., I am enclosing herewith, two
violation notices with a compliance date of March 31,
1981. Also enclosed is an application for a
building pemnit.
If you can not comply with the list of items to
qualify for a Certificate of Occupancy, you must file
for a new permit.
Failure to comply with these notices will result
in ~ court action against you; I sincerely hope you
will make every effort to comply so that this will not
be necessary.
Enclose? also, you will find application forths
for a Certifxcate of Occupancy. /
/
Y~s trul~i,/
Edward F. HinderEann
Building & Housing Inspector
EFH:ec
Enclosures
FO~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
Date .......... ~./f. .............................
TO ..C~/.?/')../~'.(~.~ ~, ,-"~rf] ....~./~Q.,~. ........... : ..........
'"~'~';'1~ ~o'~ o~'l~;;i~e~J ~gent of owner]
. ~..Y..:.z..:. Z~..r.~..~.z .Z~, ~.¥,- .~:~,'~,/v
(address of owner or authorized agent of owner)
//577
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance
Other Applicable Laws, Ordinances'or Regulations ............................................
at premises hereinafter described in that .~..O./.~.?.~..'~....~.../.~../~./.~......~.....(.~.~L?.,.~...,...(//.~'~/.7~
f (state character of violation)
>>,.~...~p,,~...; ....... ~.c .~,c'....z.~-/~z4~...~......~x,?-~/~z~.:... zz-,~. ~.,x ...
~ ~...~ ~cz-z.~-~....X.}...-.:,..-...:.....o...~.....' .~y~,x... ~.. ~.z,' ~... ,:~.~.~..,..~..... ........
in violation of ........ ~.)~--'~-.~ ....... /~'..CZ.,,-T..,/..,,~':,,.(.-.../~.~,.. ......................................................................
.(State section or paragraph of applicable Iow, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the
conditions above mentioned forthwith on or before the ............. .~.. ...................................................
day of ......... ~..~..~...~...~. ...................... , 19..~.../
The premises to which this ORDER TO REMEDY VIOLATION refers are situated at
'~.~'...~.~....~...~'/~.../,~.'/.W.~...~...~y~ .................. County of Suffolk, New York.
Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law
may constitute an offense punishable by fine or imprisonment or both.
Building Inspector
TOWN OF SOUTHOLD
OFFICE OF BUILDING II~ISPECTOR
TOWN HALL
SOUTHOLD, N. Y. 11971
TEL. 765-1802
THOMAS E. UHL
Flower Hill Building Corporation
8243 JERICHO TURNPIKE
WOODBURY. I. 1.. N. Y. 11797
July 27, 1977
Hr. Howard Terry, Bldg. Inspector
Town Of Southold Bldg. Dept.
Southold, New York 11971
Dear Hr. Terry:
In answer to your letter of July 25, 1977, the Stavros
plans are now being redrawn to match the constructlon for
the house now belng bullt.~
~hen completed, the plans w111 be stamped by a licensed
architect and forwarded to your office.
Very truly yours,
FL~ILDING CORPORATION
ThOmas ~.~Jhl~
T£U:cm
' "~i~ IRIENT~ BY THE SEA
NOME COLONY
OFFICE 692-a~5-6
8243 JERICHO TURNPIKE
WOODBURY. N. Y. 11797
July 27, 1977
Hr. Fred ¢. Letson, President
Orient By The Sea Property Owners Association
Orlent, rtew York 11957
Dear Mr. Letson:
I am not sure if I can attend your meeting on August 7th
as I have to check with my doctor first.
Regarding the Stavros house, we are correcting the plans
to conform wlth the present brick structure. The plans wlli
have all of the notations we discussed last Sunday such as
painting brick white and proper grading, etc. The gable ends of
the house will be wood with a reverse batten affect, which will
also be painted whlte. 'Mr. Stavros wlll slgn the plans and a
letter agreeing to build the house as noted.
We feel that this house, when It.is completed, will look as
colonial as many of the existing houses, as long as Ur. Stavros
builds the house In accordance with the corrected plans.
We think It Is best to allow Mr. Stavros to proceed in accordance
wlth the corrected plans. However, In order to have some assurance
that he will paint the brick and make the proper gra~e, we will only
glve him offlclal approval in writing after the house Is completed. We
wlll glve you a set of the corrected plans when they are completed.
I spoke to ~!r. Stavros about starting work 6 a. m. Sunday morning.
He said that he did not realize the noise he was making and that he
was sorry and it Would not happen again.
I belleve that when thls house Is completed, It will conform wlth
the character of the community. I will keep In touch with you as the
work progresses.
~{r. Corrado Morse ts our new sales representative. I belleve that
he stated you were concerned about the roads. We have a signed contract
with Paul Corazzlnl dated 2/3/76 to complete the roads in Section Ill and
repair Plum Island Lane In Section II. The base section has been completed
and Corazzlnl is continually promls~ng to complete the work. I believe
Flower Hill Building Corp.
82~3 Jericho Tpk
Woodbury, N.Y. 11797
1977
Attn:Thos.Uhl
Dear Sir;
Your Letter
Orient By Sea~ Orient
of July 22, 1977
E.Y. Received.
RE: S~.averos~ Lot 100~
Please be advised: The Stavros violation is more serious
than fire cuts on timbers.
Stavros submitted a set ~f Flower Hill Building Plans~ .-
stamped and signed by ),our architcct~ when he applied for a building
permit..
The house being bullt is not the plan submitted~ and is
not approved by the architect who drew the original plan. ~
The construction is in violation of the restrictions in
force for the subdivision "Orient by the Sea"~ and the property
owners association are violently objecting to the building.
I have discussed th{s w~th YJalter Uhi on Saturday PM~
July 23~ 1977. There is violation of state law involved where
the plans are dra~ by a licensed architect.
The Town has no objections to brick construction~ howeSer
we :Lust have plans by your architec% matching the construction for
the house being built. The matter Of deed restrictions is between
the land se!lot and buyer.
Please see that we get a corrected set of plans by your
architect OR stop the work under the deed restrictions in~ediately.
Yours truly
uil :ng in~pector /
CC: Wm Stavros
FORM NO. 5
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
Zoning Ordinance ,,.~..-~ .............
Other Applicable Laws, Ordinances'or Regulations ............................................
at premises hereinafter described in that ~..~...~.,.,/,&~(~.~
.~ ~stctg".c'haracter of violo~J'on)
,~:X~..~ .............. ~~~.~,:......o..z ................ '/..,. ~z.,. .......... z,:..~ ........ ~.
. /.
in violation of ...~.~C /(,~L~...,.,~.....~..~.../.~.(~...~... ~UO/~{'C. (~/'~.~-~/~ ~
(State section or paragraph of applicable law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the
conditions above mentioned forthwith on or before the ~.'///~ ..............................
day of ...................................................... , 19 ........
~The pre~ises to,~,C~;r~h~.OR,g~ER TO REMEDY VIOLATION refers are situated ot
Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law
· may constitute an offense punishable by fine or imprisonment or both.
/ ,/. ·
- - J "~'-~4~-'~7~ Buffdmg nspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
Dote ....... ~.~...~.. ....... ../....~.. .............. ,
To .............
· (owner or' authorized agent of owner)
(address of owner or authorized agent of owner)
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance
Other Applicable Lows, Ordinances'or Regulations ............................................
at premises hereinafter described in that .(.(~..C ..~.Z.~.~...~ .W......~.¢,Z.Z./.,~..~.~:.~....~/)~C.
(state character of violation) /
~-.?u/./~_~.....~.~.z~.....~,.~=.~...~z~.~r~,...c..~.,~......~...~.....-r ....
in violation of ..~..(~..../..~.~.~'....~..~..~. ........... ~:~.~... ~/~.~(J/.?..~...~--~/...~...~?~...(~-...: ................ (State section or paragraph of applicable law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the Iow and to remedy the
conditions above mentioned forthwith on or before the ...*~/.,,:~7~_~? ................................. ~
day of ...................................................... , 19 ........ ./.Z~../."~..~../
The premises to which this ORDER TO REMEDY VIOLATION refers are situated at
.'..~.~.~..~...~2'2:~...~.~..~.~'~/ ...... - ..~...'~....m.~ '~ .............. Conu ty of Suffolk, New York.
Failure to remedy the conditions aforesaid and to comply with the appliceble provisions of law
may constitute an offense punishable by fine or imprisonment or both.
Bu~ ding Inspector
STATE OF NEW YORK )
ss;
COU~TY OF )
I hereby acknowledge that I am the sole owner of the house
under construction on Lot 100 on filed map No. 3444 located at
Orient By The Sea, Section II, Town of Southold.
I hereby release the Town of Southold and the building Inspectors
from any and all responsibility for the lack of flre cuts on the
flrst floor joists at the above location.
Sworn to thls / ?
1977
~/1 LL IAH STAVROS - '
day of
NOTARY
SUFFOLK COUNTY DEPARTMENT OF HEALTH
H.D.Reference Nolo -//2/~
APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS
Approval to construct said systems is requested,pertinent data herewith:
1-Applicant
Address
2-Detailed property location
Hamlet
3-Public water supply name
4-Lot Size: Width ft. Length
Town
Date
Phone 6-Sub div
7-Section
8-Lot No.
9-Private well?
Distance to nearest main
(also enter on center plot plan below:)
5-Dwelling: Single Family ~ ~ Two Family? ~ /Cellar? / /~lab? ~__~Crawl Space? / /
10-Proposed system: Septic tank I /Precast ~ /Cesspools J /Shallow pools J /Other / /
Il-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft.
12-Precast sections: / INumber/ /Square Ft. Cesspools: Block sizeL incs. D_~ins. H ins.
Total blocks below inlet: ~1 $2 $3
PLOT PLAN
,G ~de
G W.L.
Indi
~te
No ~h
The.Undersigned CERTIFIES: "Construction of authorized installations will be in
accordance with the Suffolk County Health Departments' current Standards, Bulletins,
and amendments thereto, covering Private Sewage Disposal Systems".
Capacity Gals.
--1
G.P.M.
Data Feet
0
2
4
6
8
10
12
14
~6
18
Date Signed
Owner or Builder
FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the
opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System
can be installed on this Plot.
Date
(10/65 Revis.)
S-l§
Signed
................................... ~ ...................... ~.~ ................. ~... ~ ~ ~,,
(Buildl~ I~or)
, ~'"*~'~'~"~'~"~ ~,-
......... ..............................
..I.!.~..:..~ ......... ~o~.r h..~.~.~.m~...~s.~ ......
(A~ of ~plicant)
St~t~ wh*th~r ~pplic~nt i~ owner, I,~se~, ~ent, ~hit~t, enOin~or, ~en~ral contractor, ol~trlcio
~ of ~,~ of p~,se~- ....~ ............. [~ ~.~ ...... ~.~..~.~....~o .................................................................... ....
If epplic=nt is e coyote, sig~ture of duly ~uthoriz~ officer. ' ~
(Name and title of corpOrate officer)
Builder's License No .....................................................
Plumber's License No.
Electrician's License No...J~. ....................................
Other Tmde's License No ...............................................
Locotionof and on wh c_h pr osedworkw bedone N~oNo ..~....~..!./~'..~.7 ..~..~...~.?..~.Lo,,,2l ~1
Street and Number ....~..~..~...~..:.~...E~.[...~.....~..~......~...~r....~..?.....~...........~....~....~...~..: ....... ..~....~..!i.?~....~...?. ............. ,..
Mu~icipelity
State existing use and occupancy of premises and intended use and occupancy of proposed co~$tmctio~:
b, Intended use and occupancy ........................ ,~. ................................. .~. .......................
3. Nature of work (check which applicable): New Building '.. ............ Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................... Other Work .......... ~:: ........................ ~.,.......~...
e~..,~ ? ~ (Description)
~ o__~oo ?.~__
4. Estimated Cost .....~....-f........~............... ............. ~ ............ Fee ........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........... ~....~ ...... ,.Number of dwelling units on each floor; ...........................
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. D mens ohs of existing structures, if any: Front ............................ Rear ............................... : Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................ l~.lumber of Stories ................................
8. Dimensions of entire new construCtion: Front ............ .~....~.. ................ Rear ...... .~...7... ............... Depth ..~...~...~'/....../....O....
Height .................... Number of Stories .............. ~ .........................................................
9. Size of lot: Front .......... : ............................................. Rear .......................................... Depth ................................
10. Date of Purchase ........................................................ Nome of Former Owner ........................................................
11. Zone or use district in which premises are situated .... ~]~...~ ....... ?...~..~.....~t. ...................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~....~). .......................................
lot
regradedl ....... ~..~.~... .......... Will excess fill be removed from premises: ( ) Yes ~ No
13.
Will
be
~. 14. Name of Owner of premises ..~.....~........~..Z~[/~/~..0.,~. ............... Address ....~.:~....~.~...~..~..~.. Phone No .......................
Name of Architect .............................................................. Address ................................ Phor~ No .............. ; ........
Name of Contractor .....~..~..~.: ............................... Address ................................ Phone No .......................
PLOT DIAGRAM
ii Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from
,property line?. Give street and block number or description accord ng t° deed, and show street names and indicate
~,! whether intenor or comer at
STATE OF NE~'-~)~X I ~! J~ ~
COUNTY OF ....]~:.~.:r~.~.....~..,...,,
.......................... ~.....~...../.....~'........~....~...'~..~ ............... ............ being duly sworn, deposes and says that he is the applicon,
(Name of individual signing contract~
above named.
He is the ..............................................................................................................................................................................
(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
tht~opplication; that all statements conta.ined in this application are true to the best of his knowledge and belief; and
that the work will be performgd~in the manner set forth in the application filed therewith.
Sworn to before me this I J
..................'"'~..~..~day of :.....~~ ' .............. , 19...~.. .~. ,,- . ,~ l
Notary P,blic, .~.~l~.,l[~l..~,~,~~.. County ..................... ~ ....... ~..~..it~9¢'~...~ ..................................
· (Signature of applicant)
TERRI L~ Et,AK
ROTARY PUBLIC, State of New York
No. b2-616~295
~c~ *05
NOTE'
/;:'
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