HomeMy WebLinkAbout16248-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z19333 Date SEPTEMBER 4, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 505 MATHEWS LANE CUTCHOGUE
House No. Street Hamlet
County Tax Map No. 1000 Section 084 Block 01 Lot 17
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 15, 1987 pursuant to which
Building Permit No. 16248Z dated JULY 19, 1987
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 GARAGE ADDITION TO AN EXISTING ONE FAMILY DWELLING
AMENDED TO INCLUDE SCREENED IN PORCH.
The certificate is issued to DORIS C. IDLER
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N138468 JUNE 29, 1990
PLUMBERS CERTIFICATION DATED STEVE OCONNER OCT. 13, 1987
Building Inspector
Rev. 1/81
FORM NO. s
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)
N? 16248 z Date .........' ......l..9................. 19.17
Permission is hereby granted to-,
.���
�J !!o... ixlM........................
.K... .��.................................................
at premises located at ... .......►..1.. !...... ....�.. �....4M.L............ 44P re...........
!�QA'6................. .. ...................................................................................
County Tax Map No. 1000 Section ....(Z.11..�......... Block .......5`�d........ Lot No. .A ...............
pursuant to application dated ........... ................... 1A.1., and approved by the
Building Inspector. 1
Fee $..try .:.. .....
1""•u•". ................
LUInspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCi)PANCX
ti
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: 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. Commercial 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 completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector 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, 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 - $5.00 over 5 years - $10.00
4 Updatad Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date I. Lr. 4?. A . �./. .L.Q. . .
New Construction. . . . . . Old Or Pre-existing Building. . .. . . . // . • •
Location of
House No. Street Hamlet
Onwer or Owners of Property. f, �r. .. . ..... . .. . . . . . . . .. . . . . .. . . . . ........ . . ..
County Tax Map No 1000, Section. . . , r� . . . . .Block. . . ` 7. . . .Lot. . .. .� . .. ........ . ...
Subdivision.. ..... .. . . . . .. .. .. . . . .. . . .. .Filed Map. . . . . .. . . . . .
yLot.
... . . .. .. .. ...... .. ..
Permit Nol�0,� �1 Date Of Permit.v.V�/,��,;,O �Applicant. �lp.Q/,S„� LE/21
health Dept. Approval. . ... .Underwriters Approval..... ..
Planning Board Approval. . . . .. ... ... . . . . . . . . . . . .
Request for: Temporary Certificate. .... . .. . . . Final Certicate.. . . . .. .
� �. on
Fee Submitted: $.. .. . .
P•c,. yO (1/7 . . ... ...... .. . . ... //
Co Y,33 . . ...�`' �. ..f"
q/ 7 /GO APPLICANT
TEL. 765-1802
TOWN OF SOUTHOLD
y� OFFICE OF BUILDING INSPECTOR
c zs+ P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date
Building Permit No.l 6 2L/ O 2
Owner Zo2C S ��✓ L��
(please print)
Plumber////L �L�Du aJc�Z r
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
r
(plumber 's signature)
Sworn to before me this
o�U day of
19 Notary Public
Notary Public, -County
NOTARY a�KStgle of New York
No.4707878 Suffolk Co
Tells Expires R4 Wr 30.ISun�
THE NEW YORK BOARD OF FIRE UNDERWRITERS 1'AGV, I
BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
fuN@: 29,199U 173ki287)$7 t1 'f l t46R
Date Application No.on file
a THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
ORS. DORIS t'. ImIxR, R.R3 ,— L;0t, NATI-11 W3 DYNE, CI)TCHO(RI , N,V.
GAR 1011T
{ in the follotcing loco sftEee ent 1•ct Ft. ❑ 2nd III. .Section Block Lot
i was examined on and found to be in compliance with the requirements q(this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMi K W. AMi K W. AMi KW AMi K.W T. H P
17 25
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT TIMECLOCKS Sett UNITHEATERS MULTI-OUTLET DIMMERS
AMT. K.W. OIL H.P. GAS H.P AMi NO. A.W G AMT AMP "I AMPS TRANS. AMT H P SYSTEMS AMT WATTS
NO,OF FEET
SERVICE DISCONNECT NO.OF S E R V I C E
A AMP TYPE METERAI 10]W 1,e 3W 3 0 3W 3,e AW NO.OF CC.COND A.W G. NO OF HI LEG A W'G NO OF A W'G'
EQUIP. PER% OF pCC.COND OF HI LEG OryryF NEUTRAL
OTHER APPARATUS.
60 A14Y "1 311 NANfiAII-1
F'PNF;(+}3CTARD5::1.-9 C[R, i(10
O.F'..C. . f:-4
SMOKE Die N'CT( R: -2
TRACK f,.l'GHTTN(.:-&
O ' 38 SUFF'1)B kt1 .ft". LT�('. 1kA3+?-1?
e�
P. . 13C5X 1:38
HUNTINGTGN, NY, 117413 GENERAL MANAGER
Per w-
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.
3 31
UNDATION ( 1st )
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UNDATIOW
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UGH FRAME 4,"�' / ? V�
PLUMBING
no
SULATION PER N . Y.
STATE ENERGY
CODE ,
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FINAL
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ADDITIONAL COMMENTS : x
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76S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING 1
RE P
JARKS:
c
DATE 0 INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[4-T'FRAMING [ ] FINAL
REMARKS:
DATE INSPECTOR e
ti
rss-isos
BUILDING DEPT.
INSPECTION
[ ] TFOND TION 1ST [ ] ROUGH PLBG.
oe
[ NDATION 2ND [ NSULATION
[ ] FRAMING [ ] FINAL
REMARKS: �4417, 6i
D lie'
i_ ,
DATE ICX 7 INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ } FOUNDATION 1ST [ ] ROUGH PLBG.
[ } FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: iyD�
DATE INSPECT
A
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [l]/ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[L,Y'FRAMING [ ] FINAL
REMARKS: p
-'LP.so
DATE r a INSPECTO
V 1 BOARD OF HEALTH . . . . . .
D 3 SETS OF PLANS • . . . . . .
FORM NO. 1 SURVEY . . . . �. . . .
7OG.SDE
TOWN OF SOUTHOLD CHECK 4aEBUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . .TOWN HALL NOTIFY
TO • SOUTHOLD, N.Y. 11971
"` TEL.: 765-1802 CALL . . . . • . . . • • . - . . . .
MAIL TO :
Examined . . .�.AA4. . 19 V
Approved . . t 1. •�.9 . •, 1917. Permit No.). �? .
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
i
(Building Inspector)
APPLICATION FOR BUILDING PERMIT c
Date . . . . .. 19? . GT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted 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 Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such 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 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 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 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 building for necessary insp ct ions.
pp (Signature of applicant, or name, if a cor ration)
I (Mailing address of ap lliicant)
State whether applicant is owner, lessee, agent, architect, engineer, ge ral contracto , electrician, plumber or builder.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises a�qjo. �. . � y?`%yy
(as on the tax ro 1 or latest dee )
If applicant is a corporation, signature of duly authorized officer.
. . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name and title of corporate officer)
ALL CONTRACTOR' S*U T BE SUFYOLK COUNTY LICENSED
Builder's License No. . . . . . . . . . .
Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
1. Location of land on which proposed work will be done.. 5-.0. S. . . . . . . . . . . . . . .
House Number Street a Haml,91
County Tax Map No. 1000 Section . . . � .y . . . . . . . . . . Block . . . . . /. . . . . . . . . . . . Lot . . .j . . . . . . . . . . . . .
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 t
. . .Q . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . . . . . . . . . . . . . . ... . . . . .. . . . . ;,, .. . . . . . . . . . . . . . . . . . . .
3. Nature of work check which a / ) �y
Rem plicable): New Building . . . . . . . .
. . Addition ... . .�, . : : . . . a . . . . . .
Repair . . . . . . (. Oval . . . . . . . . . . . . . . Demolition . . .�. . . . . . . O W rk .
,��c_�e� ��1Z�ed�c� Gy�Z �e— Grr-C�,G> e es_r�:aion)
4. Estimated Cost . 20. .Q.E/ . . . . . . . . . . . . . . . . . . . . . . . . ./Fee . . . . . . . :`i aP L,.
(to be pai(ljgr}. Ii<?
_ ,P t}fi= "ficatro
<
5. If dwelling,number of dwelling;unit Number of dwelling units on each floor . . . . . . . . . . . . . . . .
Ifgarage,number of cars . . . . Cr" . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. If business, commercial or mixed occupancy, specify nature and extent of each type otl use '.'. . . . 1 . . . . . . . . . . . . . . .
7 Dimensions of existingstructures, if any: Front . . . . ... . . . . . . . . . Rear . . . . . . . . . . ... .. ."Depth'. ... . . . . . . . . . . . .
Heightberof Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . .
Depth . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . , . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . .
Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . :,
Height . . . . . . . . . . . . . . . Numberof Stories . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front . . . . /� . �� . . . . . . . . . . . Rear . . .`. . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . .
10. Date of Purchase ..�( � . . . . . . . . . . . . . . . . . Name of Former Owner ENE ST . .8 ll�h7. � . . . . . .
11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No
14. Name of Owner of premises . . { . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . .
Name of Architect . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . .
r. .
Name of Contractor O d . . 7 c.64 VS f� N . , . Address FRST. tYi -7. R/P `J. . . Phone No. . . . . . . . . . . . . . . .
15. Is this property located within 300 feet of a tidal wetland? *Yes . . . . . No . . . . .
*If yes, Southold Town Trustees Permit ma be required.
PL& DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from
property lines. Give street and block;number or description according to deed, and show street names and indicate whether
interior or corner lot.
II
STATE OF NEW YORK, S.S
COUNTY OF . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . i. . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(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.
Sworn to before me this
S� n
Notary Public, . . .!`.`. .��.��. . . . . County
"Aft NRENKDEVof New Yak DE
PUBLIC Side (Signature of applicant)
No.1707l78 SonoIp ceuoy
Tam Expires kljxeh 3p,19�
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY.
a -7
THIS INDENTURE, made the day of nineteen hundred and
BETWEEN ERNEST RANDALL and LOIS ALL, residing at 505 Matthews Lane;
Cutchogue, New York
I
party of the first parr, and
e .
DORISnIDLER, residing at 1010 Maple Lane, East Marion, New
York
party of the second parr,
WITNESSETH, that the party of the first part, in consideration of Ten Dollars and other valuable consideration
paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or
successors and assigns of the party of the second part forever,
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate,
DISTRICT lying and being in the Town of Southold, County of"Suffolk"ind State; of,Neu-York, known
1000 and designated as Lot No. 4 an a certain mhp'entttlktd, 1t14ap-of Northwoodstt and
filed in the Office of the Clerk of the County of'Suffolk'on Mhy 21, 1970 as Map
SECTION Number 5469.
084.00 y
BLOCR
01.00
LOT Q
017.000
6-7
TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and
roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and
all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the
premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the
second part forever.
AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby
the said premises have been encumbered in any way whatever, except as aforesaid.
AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first
part will receive the consideration for this conveyance and will hold the right to receive such consideration as a
trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the some first to
the payment of the cost of the improvement before using any part of the total of the same for any other purpose.
The word "party" shall be construed as if it read "parties' whenever the sense of this indenture so requires.
IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above
written.
IN PRESENCE OF:
ERNES
LOIS RANDALL
3290
Standard N.Y.B.T,U, Farm 8002. Bargain and Sale Dead,with Covenant Aeaim,Grantor's Acn—Individual er Corporation.
- STATE OF NEW YORK, COUNTY OF SUFFOLK as; STATE OF NEW YORK, COUNTY OF SUFFOLK as:
On the 28 day of March 19 87 ,before me On the IS,I E; j day'of 1.l9une 19 87 before me
personally came personally came
ERNEST RANDALL LOIS RANDALL
to me known to be the individual described in and who to me known-to be t�e individual described in and who
executed the foregoing instrument, and acknowledged that executed the foregoing instrument, an knowledged that
executed the same, executed the same.
l - I
I �
ADOL J. i1C HARDT NolrAp pH
NOTARYN BLIC St Is of New York
g,ey 0 yety c�. No B30 Slot oAROT
To""cliWirti� /1r�9JO 0 TolIINTed In �ou00 NOW York
STATE OF NEW YORK,COUNTY OF no STATE OF NEW YORK,COUNTY OF Y ul
On the day of 19 before me On the day of 19 before me
personally came personally came
to me known, who, being by me duly sworn, did depose and the subscribing witness to the foregoing instrument, with whom
say that he resides at No. I am personally acquainted, who, being by me duly sworn, did
'.... depose and say that he resides at No.
that he is the
of that he knows
the corporation described
in and which executed the foregoing instrument•, that he to be the individual
knows the seal of said corporation; that the seal affixed to said described in and who executed the foregoing instrument; that
instrument is such corporate seal; that, it was so affixed by order he, said subscribing witness,was present and saw
of the board of directors of said co'potation, and that he execute the same; and that he, said witness, at the same
signed h name thereto by like order. time subscribed h name as witness thereto.
i
BARGAIN AND SALE DEED SECTION
lWITH COVENANT AGAINST GRANTgR's ACTS BLOCK
TITLE No.
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Ofl COUNTY OR TOWN
1'bd.
Itf'UI) TO Recorded at Request of COMMONWEALTH LAND
UVOCY. TITLE INSURANCE COMPANY
- ,I r 1, i 10 RETURN BY MAIL TO:
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SUEDIV/S/ON NAP FILED IN ME OFFICE
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YOUNG YOUN c�pRD
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EH w y _-_ A0619,1975 400 OSTRANDER AVENUE, RIVERHEA N WAY( � G
I I ALDEN W. YOUNG L WD Af�(a'ry•�,; UtiG A
e!O PROFESSIONAL ENGINEER AND N. O IC4
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LAND SURVEYOR. N.Y.S. LIC. NO, 12845
P,`1a2h� SURVEY FOR: �F�J`t 4ss�s
UNAUTHORIZED ALTERATION OR dD01T10N TO ERNEST RANDALL 8 LOIS RANDALL 14ND SUR,
THIS SURVEY IS A VIOLATION OF SECTION (J
0^ LAW OF THE NEW YORK STATE EDUCATION LOT A/O A "A/ORTHWOODS
LAW AY 'f �V
qh \O COPIES OFT VEY MAP NOT BEARING
�O� THE US INKED
SEAL OR
EMBOSSED SEAL SHALI,�NOT BE CONS-DEPED
GUARANTEED TO:
To BE A VALID TRUE PY D a $ AT E- ERNEST RANDALL 9 LOIS 17ANDAU
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,,.> `GUARANTEES INDICATim"EON SHALL RUN TOWN OF NOW TITLEDIVIS/ONOFCoWCAGO
2 ONLY TO THE PERSON FOR WHOM THE SOL17-HOLD T1PLE INSURANCE CO
. ^ SURVEY IS PREPARED,AND ON HIS BEHALF .`\y�
c TO THE TITLE COMPANY,GOVERNMENTAL '\ I
_ AGENCY AND LENDING INSTITb1:ON LISTED - .SUFFOLK CO., N.Y. aw pwr,�24.J
HEREON,AND TO THE ASSIGNEES OF THE 1•1
LENDING INSTITUTION GUARANTEES ARE
NOT TRANSFERABLE TO ADDITIONAL SCALE: /u_ 4O-�' DATE: MAY/6, /975' NO• 75-2B3
.... INSTITUTIONS OR SUBSEQUENT OWNERS.