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Home My WebLink About10627-z FORM NO.4 TOWN OF SOUTHOlD BUILDING DEPARTMENt Office of the Building Inspector T own Hall Southold, N.Y. Certificate Of Occupancy 210376 February 3 81 No,..............., , Date . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . ., 19 . . . THIS CERTIFIES that the building ,. . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LocationofProperty .,. .23.5. .~ar.r.atp.o.lta. L.a.n!),...,...... .~II.t.I;;!.j;J1.<<I!:.. ~"'~""'" House No, Street Hamlet County Tax Map No. 1000 Section ..... .1.1.~ . . .Block ....... .q~ . . . . .Lot . . . . . . . .~ ~ ~ . . . . . . Subdivision. . . , . . . . . . . . , . . . . . . . . . . , . . . . . . .Filed Map No. ....... .Lot No. ............. eon forms substantially to the Application for Building Permit heretofore filed in this office dated April 9 80 " .. 10627 2 . . . . . . . . . . . . . . . . . . . . . , 19 . . . pursuant to which BUlldmg Penmt No. ..................... dated ..,.. .A.P.t: ;J.;t.. .1.Q .. , . . . . . . . . . . 1913.0. , 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 ... . . . . . . One car garage accessory structure. .,.... .................. .... ............... .......,..... ,. ," ,. ... ... ,.. ........ The certificate is issued to ........J: <??!1. .r~! . i3.r:uf.l;3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . (owner .I_a Ql'JfVI6lJ.tJ. ~ _ of the aforesaid building. N/R Suffolk County Department of Health Approval ....................... . . . . . . . . . . . . . . . . . . . N 507389 UNDERWRITERS CERTIFICATE NO. . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I Rev.I/S1 I , ; .,..,,- Lid ',.0- J ," FORM NO. 2 TO~N OF SOUTH OLD BUILDING DEPARTMENT TO~N CLERK'S OFFICE SOUTHOLD, N. y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10627 Z Date ..~/..k......./.,.............,..., 19.r.Q - Permission is hereby granted to: AtEfiF"v( ....:J;cUA....A.:. ....?!.4!.A:~"'. .l(.".6).ct/,. ',. Ctj'&' fV&........J04M..L.....Qgl./.A..I.$.....~......... .- ..........M&.1.&..IfI..f<.&.;::.r.Y...7.....,..,."..",.. ,. to ....c.Q.I0..~&.c.Qr:.:..r.:......QA.t......C4.1.'Z:.....GdI&:t1I.e,c::.....6ICCE::;$O.I:<;:..~l... . .. ........:::!7.:&."-~W.~.............,................,. .. ....'...........;{;...........................'........................ . at premises located ar#...z.$..fi.'...&~F.:A... ..15ILE:T.................................... .. .....,...........................................................,.............. ...........................&Al1t.tv.cl:./..M.7:....... ...................................................;.4.........'....."................................................................,............... . ~ !' pursuant to application dated .:~.<.I..(.........,....... ,....,..........,.., 1~., and approved by the Building Inspector. ' : 'Q dt:o' i Fee $..t.! ....:::::......... i . j .if , FORM NO.6 TOWN OF SOUTHOlD Building Department Town Hall Sauthald, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the follawing; far new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural ar topographic features. 2. Final appraval of Health Dept. of water supply and seweragedisposal-(S-9 farm or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Cammercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Cade compliance from the Architect or Engineer respansible for the building. 5. Submit Planning Board approval af campleted site plan requirements where applicable. B. For existing buildings (prior to April 1957), Nan-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty shawing all property lines. streets, buildings and unusual natural or topograph ic features. 2. Sworn statement of owner ar previous owner as to use, accupancy and condition af buildings. 3. Date of any housing code ar safety inspectian af buildings or premises, or other pertinent informa- tion required ta prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Capy af certificate af accupancy $1.00 Date . . . . . . . .~ !..?tJ. /:r. ~. . . . . . New Building. . . , .L::. , . . . . Old or Pre-existing Building ........,... Vacant land ............. locatian of Property .~. ?..r~. . .. .. .,. .. .... m.~.t:'.V:ifo.;j'PJ. ~'i\. iif1.fJ.e. .... . .1!1<!-.<<.1. fficJc House No. Street Hamlet Owner or Owners of Property...). ,fJ. Q. ./0'). . /.-:..'. . !? r:<< t:J J . . .. . . . . . . .. . . . . . . . . . . . . . . . . .. . . . County Tax Map No. 1000 Sectian ... !.4-!~. . . , .. Block,.. tp. 'f:. . . . .. Lat.. Pc::? !. .. .' . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . . Lot No. ............. Permit Noj06/lJ..:0 Date of Permit iI1J?~.APPlicant. .'P.dJa... .f3....0.n):::~JixI.~..... Health Dept. Approval . . N. :. R. . . . . . . . . . . . . . . . Labar Dept. Approval ...............,........ . tV 5073f?9 . Underwriters Approval. . . . ., . . . . . . . . . . . . . . . . . .Plannlng Baard Appraval ...................... Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate.. . . . . . . . . . . .. . . . . . . . . . Fee Submitted $. .f I?? 9. . . . . . . . . . . . . . . . . . . Canstruction on above described building and permit meets all applicable cades and regulations. ~ Applicant .~h..4. .~~...... .~o~...... .1' \ I (/ -,.,." t"~~Y' ~I, ) ~ J;'O~ V1f' , j t-J..ll ,J, >..ii .' , _,_~,_ _ _,~ --""'.J-' !,' . (r - ,....,. !:'l.:c-'~._::._i'r:c.:.:c..:'.~--". ...~____.;i~'~.:.':. h~~ c'_ L_ E _. -~- > -_.--- - 'D' - 1. -- . ----- -------'~t"'V ~-~(/"I~ ~ 9.13. -r() f-~ =---~ ~~ t'J~ ______ .__________.~.__ _________ --,----- '- I JOUNDATIQ".! _ --11st) ~ i ..... . N b~ FOUNDATION (2nd) N 2. N ROUGH FRAME & 7~ PLUMBING .\ , ~ ~ I~ INSULATION PER N. Y . c+ ~ STATE ENERGY ~ CODE , ::r:: . 1\>_';., 4. p~ - "ii/.1./~t7. ;:J-A -Jl rc!h ./ ~"1 ./ II/ FINAL ~'~L ('C!.../// ' - ~ 7' ~~1 :3~ CD . ADDITIONAL COMMENTS: \ 'i~ ~ 't' '^ , ~~ TI~ ""y 'i ~~ t~ :3 f- ::r:: CD .'. I\> , ~j . CD I !. ",I, LJ L Ji ." i ~ , 1~ ;' ---~_._- I THE NEW YORK BOARD OF FIHE UNDERWRITERS ng BUREAU OF ELECTRICITY I r- 85 JOHN 5TREET. NEW YORK. NEW Y.ORK 10038 Date .1[jI11..l1P.Jr 26, 1981 Application No. onfile 098646 - 80 N &>071:19 THIS CERTIFIES THAT '!.,. - i ~~'", only the electrical equipment 4S described below and introduced by the applicant r,i.amed on the above application number in the premises of Willi.am lIrikelb8<:h, 235 a/s Mar:r.e.tooka La,. Matt:i~, N.Y. in the following location; rn Basement []j 1st FI. o 2nd Fl Garage Section Block Lot I was examIned on JmlU'lry 22, 1981 and found to be in compliattce with the requIrements of thi<; Board. i FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOkiNG DECKS aVENS DISH WASHERS EXHAUST FANS ~ OUtlETS INCANDESCENT FLUORESCENT MER URY AMT KW AMT KW A!!<T KW AMT K W AMT H P .1 VAPOR 2 J 3 2 1 1'1 ~ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BEll UNIT HEATERS MULTI-OUtlET DIMMERS ~ SYSTEMS A!!<T KW 0" HP GAs H P AMT NO A W G AMT AMP AMT AMPS TRANS AMT H P NO. OF FEET AMT WATTS 1 SERVICE DISCONNECT NO OF S E R V I C E AMT AMP TYPE METER NO Of CC COND A W G. AWG AWG .~ EQUIP JJ!2W lJ!3W 3H3W 3j!4W NO Of HI lEG NO Of NEUTRALS PER/ir OF CC COND Of HI LEG Of NEUTRAL ~ i;1 OTHER APPARATUS, Ii !iN I-G~:F..Cllr.. iJ l!I ! i ~~-( I Dettnm: Elec, GO. P.O. ,1J4fX 482, RivedlA.'!ali, N, y, 11901 lie. 643-E GENERAL MANAGER I '/: ~ 11 ././ Pi' ;e: L, "_ i This certificate must not be altered In any manner, return to the office of the Board ~f i.~cotrect. Inspecto~s may be identified by their credentials COPY,FOR BUILDING DEPAR MENT, THIS COpy Of C,ER!I'IFIC4cT~, ,,- > <, 'r -j -'.'" . '"i-,', ~ ~g --# . ~~ pc- (I> ..'. ~.. .... "- Q." 7~ :1"'\,)'<' ...... ". "" '" .. ::::'-""" U' _, ....... '" ^ '," OJ 1.1 \ . ". ;- (\ . '~~ - -""" 11> ~ r-> " ,.. .~ ~~'. ~~> ~ ,:'$_ .. , ~:n~, t~ _. 0" ::P ... ~~ ,.,.e', "'". .<!"~. ~' <1'\ ~ ~I- ..\0- ~'!'I!' ~.#r-f> iK0~<:,,~ ". ~~~~'''"''''\\~. .... 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'-i ~-," ~ ".t. . , "" . -. o.ri ; j, '" ' ' ~ t;:J 11' n ~r-~ =--:' -;-:------- -;:,:7~ :' ~;' - ~ ")( wr- ! -;~~~:~l.;c~" <J CO 1 :. --'.f'l ' it, 1_ ,., APPii.OVE!) AS NOTED . ," 'co 0 c.. . ~. 'fu f,' ~/.0 ~ 7. '", jt;i~,;,r>'. ;i,:.' '0 \'J =.-, . .?;.. :. f K ~,1-. ATE'~/t. BP. '# z-7'C . "j'i;""'", ",,- .., 4-! .... . ,I ~~ it E: 7<;1i5;-:;a ~ ,'-,,-:.i.ity-,..<,~,"_ J!:~.I , .",,1" E. - BY' 1 .J" ~ .\. .'.' ~ .'r~"~'~~"r--.....-;t:..-- (I ._~.- .. ~-_. - ....~---- . - . ?f;::i':lyf ,'; . 1 .." '" >i-;- (~ ,,~ OTIFY BUILDING DEPARTMENT AI; .-;n':'~;,1"-+7"'::?>' g ~ ~ ~r 65' -18. "2 9 AM TO 4 PM FOR THE.' : _~,;t'~',..~il~:. _" ,-~' _ ~ ~f -n Co _ ~ ~ ~f QLLO~fJr~'r) 1t"";S;;t?C;TIONS' H 1f.i _::. ~ ~~, (\ ; 1.: FOU'dl-'I\TIO~J " TV/O REQUIRED .... .-_ ."- . ,,'oJ_. 't " r I ;;: (" ,;.. ; FOc> '00,1 'iFf') CONCRETE ! '/ ~o "",--- t 2. i RO!J(-:"I - FF/\/VdNG & PLUMBING t '--r' - 1""" If> ~ "V3:'TN5UI/\'ON +,... , .1 :..'..1 I <:+0':..' . t'..f';,FIN.I/'1 ' (,0~15T',R,iJCTION MUST , i . 7 9", h ,BE C"'H"I l'lT FOR C. 0, (. ~: [" ..-.... I / ~Js,~. t'A~L tDN,TR'JCTION SHALL MEET I' ,.,.,...~ ....!._- . I, -- ,'-1 (i; f ") ;.:rHl, E. REQII'r:"-MENTS OF .THE N Y. ". ,'. k: , ; :., . ~"o ,'(-. ,'" 1{s.riAT~ CONSTRUCTION & ENERGY i ,.!e;.i i;, o~ ,,~ I,~CP-DEP." NOT RESPONSIBLE FOR: I,. ' .... T" 17;" 'I"" >,. ' ...". ......._,J."."... ~JGN..QILCONSTRUCTJONERRORS, ~~.""\?~:!'"1!:':'7"t'.- .1.~"),t'11m?,\~T ".~ -.; 1w~'~f: r;: ',. ,r. .',) ,.~:.,.N>,4,:",,~~'~"V*""7)' iZN'\'~),:"""'~1!x'w~;;&,!;1",'w.,q~~f:~~,';'2:t~-~m1I!~$r-!\~"~."",,,,, ".-"'t.-.c''''~":''''~'''_ '''" " ~, '_,' _.,"^_",-' ^'~,,,v,,:- I ~." ~ \ I I .. -" " I ! ,~ M~C2QC':ITOO{.-.::.t) L~NE I i~ ! 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'.' c. ~, ~ ::t . III IJI -. ~ '" ! ~ 'lI ,. n C,.,;t (j) \r' Q : D"""'~-C II) II I " (J, .. "\ () ~ J) j:) -: I i -;'k:f ~ l~d :.. I. . ....' >'{'l I '""" 1 <It' 1 , J ~ u) ; " -' ~ ~ 0 ~ ~ ~ ~ ~ ~ ~ 0 ~ ~ g g ~ 0 ~ " . ~ l I ic1 -;.. +- H~~tn"::~ "g>~ ~ggs =::-7-- , I <:. 1\)- 0 . =-C$::;:g~o~ >G~o {5 V1,% ____.___ I ./ ~. rs ~..... ~~"'.'i"ii'r;: ~"1!:;-i~fi'L__...:,.-_.._-_...... " .--------~- r. ' I O't..r: " ... ~'""::t F; ~: ~ ~ * ~ "",. z. .tJt-;'~ ~ ~ ~-~ S ' i ,,/ I ... 0 "h " ,,~ ,. N' "",, .. '^.. 0 ~,. , ..-== '= I' _} . \J H G1 ;.; II> (' I:; i~ A 2.J: 0 ~ . ... (;i ... '\- .~ il C. ) . --C.. ~ U Q ;>' ~ 0 ~~ ~ .., ~ ~ < fi )> 5 t r , . .... '-3 s> :;) r: r. "J: () I.:' 8 z ~ ~ z -< ~ I'... I "'. ~ Ghi:~:..."~O'.>:c ....(.'~.,~ ....5Q II , ~ ~,:;.:..~'F..~;<-<&1; ~>z 1'-,.1 . <::,-.,00" ~~o Il' ~ $. 9:~F ?:~f\"i! f)~5-' 20"" , \'"_~ ~~~,.. ~'!'r 0.-..., ;><:Z,. ,- ...~ I~z' ~~~;: ~2~ ~QE . it.! \} ..">..,,~,, - ~ ~ 6 . J' ~ 'C"'6""-~~- ;; ~ '" 7 " . ~- --< , --"'--' - .--.-----'1 i---l...,- - ---___ -----_ . I-< i/ t. ,,: Er if H___._.~____~~ -------~---- , &",,^,,_.~- . ,~ ,'._~, m ~._... 'n>', ~. _,~ ;".,'" . FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH OLD, N.Y. 11971 TEL.: 765-1802 E'=;'''d~ j{...., 19fQ Application No. ((J.(.?}... ..... . Approved. f# .i6...., 19J?>. PennitNo. .!(J.f;?;76 Disapproved a/c -,- - .. ..... ........ ....... .... .......... .... ............ ... APPLICATION FOR BUILDING PERMIT Date~ fC:.(?.. . .1. . . . ., 19 cfQ INSTRUCTIONS a. This application must be completely filled in by typewriter or in .ink and submitted in triplicate 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Pennit. d. Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such pennit shan 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pennit pursuant to the Building Zone Ordinance of the Town of Southold, Suf(olk 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 buildings for necessary inspections. ..--" ~(..'a. . . f<-. ~(L(!;~p~r;/:f... . . . . . . . . . . 6'.0 i<' ?1 (Signature of applicant, or name, if a corporation) .... .I.I?J.{/.~(<;-. .-:-!.'. ~.\................. ---.--- (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. ........... ....... ........ ... ... .......... ...... .... ................... ...... .... ............. Name of owner of premises ..... J Q/.9!oJ. . . L... . .I~ @. if.I.~. : . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .......... ........ ..., ....... ... ....... ....... (Name and title of corporate officer) G.:; '-7~ Builder's License No. '7.t1~1.. /.t:,/.t. ?; ~. . . . . Plumber's License No. ........................ El t" , L' N ~Q /)EI/fi.JC/c". ec nCIan s Icense o. . ~ .:............... , ,\ Other Trade's License No. ..................... 1. Location of land on which proposed work will be done. ................................................. .. .2.:;.S?.......... .H/.Y<<~To.Q.0J.. ./'~!-!.~...........,. .f.i?7Ji.7C!. C;;/~...... House Number Street Hamlet County Tax Map No. 1000 Section ... ./1/5:. .. . . . . .. Block ..q.<f............ Lot... ().Q./. . . , . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. .............. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~ ~ a. Existing use and occupancy. .(l)/L,E. rl9/../i.(..j.. . i2$'/.p.~t..4~.......................... b. Intended use and occupancy ACCE::;1.S'~.. .gpA:AJ.~. . . . . .~ . . . . . . . . ',' . . . . . . . . . . . . . . . . i 1 ! L ~~,k. '"",..',k1. ",Ji. , .. .\.': 3. Nature of work (check which applicable): New Building . .~ . . . . Addition. . . . . .. . .. Alteration ~ !\. .. . ~ Repair ......,....... Rem:oval . . . . . , . . . . . . ., Demolition .............. Other Work. . . . . . . . . . . . . . . _ ' #' I 0 o;::n:.. (Descriptian) 4. Estimated Cost. . . . . . . . . .~ (:!J.t:? ~. . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . ~. . . . , . . . . . . . . . . . . . . . , . . . : (to be paid on f1Iing 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.I)~re and extent of each type of use .. . . . . . . . . . . . . . . . , . . . 7. Dimensions of existing structures, if any: Front. . . ~. . . . . . . . . . Rear .. ~<f-. . . . . . ., Depth............... Height ............... Nmpber of Stories ., .~'.......... ..... .. ... . ........... .. .,..... ... .. Dimensions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . .:. . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth ............... Height ............... Num.J;1m; of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . 9. Size of lot: Front ...7~ .!~.../.'Ck.ZRear.. ..~..... ........~th .. ....~ .......;,..:... ... 10. Date of Purchase .... .1.'04 7. .'1. . . ., ........ Namt\.09~rmer Owner zJl{JM~. .~Q-:9CJ.lz;;. . . . . II. Zone or use district in which p~emises are si uated . . . . . . . . . . . . . . .(~ . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . 12. D?es proposed construction vi~"late any zoning law, ordina~ce or regulation: .... K.Q. . . . ',' .: . . . . . . . . . . .~ 13. WIll lot be regraded ...: '~"'7'.'''K''''''''" . . Will eX9:ss fill be r mo~!:!:Pm premlses,(/7 _Yes ~ 14. Name of Owner ofpremlses~.wh~ .I.-x.-/C./-..J?. . AddressF.~ E'f.9.:t.~;;', Phone No.,...;. pf..s:.-: (.~.'1. .. Name of Architect ........ '1' '7."'?'Tl: . . . . . . . , . Address.. ":t<!7.7.ctf:.-. f:~ :Phone No. . . . . . . . . . . . . . . . Name ofContractoro/#I1A"I;" .t.t..JH. ~ .t::......... Address . :CIc:lS,Ql't.-. . . . Phone No.7.Z-7.-: 5.4(/... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocM number or description according to deed, and show street names and indieate whether interior or corner lat. , ~r/~~F~~~ I , STATEOPNEW~R~.r-I/.I : S.S COUNTY OP<"""::::;>IrTf:T;'l:I ,A."..: . . . . . . . . .De-I;tf<.-r. . . . .:E. . .t.j.N.Ke....L.bIlDk. being duly sworn, deposes and says that he is the applicant (Name of individual sigping contract) above named. I 5He is the .......... ./e..s$'.c::.CJ,i.. .~.. ..o.I.'t'>.p.<?-~........................................... : (ContVactor, (gent, rporate officer, etc.) of said owner or owners, and is duly authorized to perform r have performed the said work and to make and file this application; that all statements con~ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manrler set forth in the application filed therewith. Sworn to before me this i ............ .r:-fh...., .dayqf..... .A.pn'l... .., 19.8:0 NO~~'j;U . .... I' . .. & iJ::co~t, . ;1 C, r BETH ANN EVI ...J~~.. .. 1 N01'l\RY PUBliC, St.t. \)f .w vorR (J, . . No 52-8125850, Suffolk Cou~ ~ '(Signature of apphcant) t..rm EXClres March '30. 19,~