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Home My WebLink About24976-zFORM NO. 4 TOM OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26688 Date: 09/15/99 THIS CERTIFIES that the building NEW DWELLING Location of Property: 10947 NORTH BAYVIEWRD (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 79 Block 5 SOUTHOLD (HAMLET) Lot 20.11 subdivision Filed Map No. Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 17, 1998 pursuant to which Building Permit No. 24976-Z dated JUNE 24, 1998 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 FAMILY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR. The certificate is issued to VIRGINIA PRINCIPI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-98-0041 ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 08/09/99 N-496671 08/04/99 09/08/99 EXCELSIOR PLUMS&HEATING Rev. 1/81 FORM NO. 3 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) PERMIT NO. 24976 Z Date JUNE 24, 1998 Permission is hereby granted to: PLOCK & OTHERS PO BOX 973 CUTCHOGUE~NY 11935 for : CONSTRUCTION OF A TWO STORY SINGLE FAMILY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR. at premises located at County Tax Map No. 473889 Section 079 pursuant to application dated APRIL Building Inspector. NORTH BAYVIEW RD SOUTHOLD Block 0005 Lot No. 020.011 17 1998 and approved by the Fee $ 485.20 Application Fee + 75.00 560.20 Includes $100.00 Flood Dev. Pemit ORIGINAL Rev. 2/19/98 BUILDING DEPARTMENT TOWN HALL 765-1802 ~APPLI~ATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the buildir inspector with the following: for new building or new use: *'1. Final survey of .property with accurate location of all buildings, property line~ 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 build~ and installations, a certificate of Code Compliance from architect or engineer responsible for the building. ~.Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings Ppre-extsting" 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 applicar If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, SwSmming pool $25.00, Accessory building $25.00~ Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildinm - $100.00 3. Copy of Certificate of Occupancy - = .25C. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ................... Const ctlon.. ..... Old Or Bnild* g ........... House No. Street Ha~et Onwer or O~ers of property .................... / ...................................... co~ ~ mp ~o ~o0o, s~o~ .... 2~ ......~k .... ~ ..........~o~.gR:[/ .......... Pem~t No ................. Date Of Pemtt ................ Applicant. /~. · .... Health Dept. Approval...........-...--.--------Under'rets ApprovaZ .................... Planning Board Approvai Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................ .... ..... .......... SOLDER CERTIFICATION Building Permit Owner: '~[~t C lead,. I certify that the solder used in the water supply system contains less than 2/10 of 1% Please Check One: ( X ) I certify I am the Licensed Plumber (License # 2433P), that installed all plumbing on the above referenced premises. ( ) I certify I am the Homeowner and I personally installed all the plumbing on my above referenced premises. / /// . Plumbers/or Homeowners Signature Sworn before me this ~ day of ~(~/07-~,~'/'3'CT'''C ,19 ~?~, N~lk ~nty ~ Notary Pffblic . a~~ UNDA 8. PUGH N0la~y Public, State of New YOIll No. O1 PU5057908 (2u~Jlfled In Suffolk County FOUNDATION (1st FOUNDATION (2nd ROUGH FRAME & ~PLUMBING' INSULATION PER N. Y. STATE ENERGY CODE COMM[NT£ FINAL ADDITIONAL COMMENTS: CERTIFICATE ]996 ELEVATION FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this cedificate does not provide a waiver of the flood insurance purchase requirement. This ~orm is used only to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE aUILD[NG OWNER'S NAME POLICY NUMBER Richard Principe & Virginia 0'Conor-Principi COM~ STREET ADDRESS (including Apt., Unit, Suite and/or Bldg. Number) OR RD. ROUTE AND BOX NUMBER Bayview Road~ P.O. Box 512, Ama~ansett, NY 11930 OTHER OESCRtPTION (Lot and Block Numbecs, otc,) 1000-79-05-20. ll CITY STATE ZIP CODE Bayview - Town of Southold New York 11971 SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. CATE OF FIRM INDEX ] 5. FIRM ZONE 6. BASE(in AoFLOOCzones. useELEVATIONdepth) 360813 0167 ..... C May 4, 1998 I AE 8 7. Indicaie the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ~L~ NGVD '29 L~ Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE:' ; I ! I i ! ! feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 2 2(a). FIRM Zones Al-A30, AE, AH, and A (with EFE). The top of the reference level floor from the selected diagram is at an elevation of l , , i , 3,~_ feet NGVD (or other FIRM datum-see Section B, item 7). (b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the setected diagram, is at an elevation of L i J i J J i~ feet NGVD (or other FIRM datum-see Section B, item 7). _ (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is i ; !.~l feet above ~ or below ~ (check one) the highest grade adjacent to the building. . , .~_ feet above~ or below ~ (check (d). FIRM Zone AC. The floor used as the reference level from the selected diagram is ~ ' ~ ~ one) the highest grade adjacent to the building, If no flood depth number is available, is the building's Iowe~st floor (reference level) elevated in accordance with the community's floodplain management ordinance? ..~ Yes ~ No ~i__Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: ~ NGVD '29 ~- Other (describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: ~ Yes ~ No (See Instructions on Page 4) 5. The reference level elevation is based on: ~ actual construction ~ construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference/eve/floor in place, in which case this certificate will only be valid for the building during the course of construction. A pest-construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is: L ! , 11 !0 .feet NGVD (or other FIRM datum-see Section 8, Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: i I I I i I.LJ feet NGVD (or other FIRM datum-see Section B, Item 7). ,,MA2. Date of the start of construction or substantial improvement Form 81-31, MAY 93 REPLACES ALL PREV1OUS EDITIONS SEE REVERSE SIDE FOR CONqlNUAT1ON SECTION E CERTIFICATION T ......... o be si-ned b- a land surveyor, engineer, or architect who is authorized by state or local law to certify e. lev.atlon nseer[irca[Ionls[ 9 ~' · ..... on ^: ^u ~, ,~,th m~='~V~ V3OVE end V /w th BFE isrequrea nformation when the elevat on fnformatipn rot ~ones ~-~..,*~, ,~ ...... ~.~ ....... T'¢ '- ' ' "' ' "o ma" aisc sf"n the Community officials who are author zed bY local law or ordnance to prowde flooop a n management informau n, y certification. In the case of Zones AC and A (without a FEMA or community issued BFE), a building offiqial, a property owner, or an owner's representative may also sign th? certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features-if the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equ'pmant, area use, wa I open ngs, or unfinished area Feature(s), then list the Feature(s) not included in the certif cation under Comn]ents below. The diagram number, Section C, Item 1, must still be entered. I certify that the information in Sections ~ and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement m.ay be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME i LICENSE NUMBER (or Affix Seal) John Schnurr I 49517 TITLE I COMPANY NAME Land Surv~ior/iPartner Young & Young i CITY STATE ZIP 400 Ostr~der IAvenp~ Riverhead New York 11901 July 28, 1999 (516) 727-2303 Certi Icate for: 1) community official, 2) Inaurance agent/company, and 3) building owner. SIGNATURE Copies should be m¢~l~ of this COMMENTS: ON BLAB A V ZONES ZONED The diagrams above illustrate th Elevations for ell A Zones should Elevations for all V Zones shouk WITH ON PILES, BASEMENT PIERS, OR COLUMNS, A A V ZONES ZONES ZONES ' SASE FLOOD ELEVATION points at which the elevations should be measured in A Zones and V Zones. be measured at the top of the reference level floor. be measured at the bottom of the lowest horizontal structural member. Page 2 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]~LATION [ ] FRAMING [ ~'"] FINAL [ ] FIREPLACE & CHIMNEY ~ATE ~/~:~ INSPECTO~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~SULATION .,/ FRAMING [/~FINAL DATE //~~ ,~? INSPECTO~ 765-t802 BUILDING DEPT. INSPECTION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY .-MA. KS.. DATE INSPECTOR 765.180:) BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROU~.A4'PLBG. [ ] FOUNDATION 2ND [/-/]~ INSULATION [ ] FRAMING [ ]FINAL [ ] FIREPL~/~C~HI~EY ~ REMARKS:~ , INSPECT~/~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]/~)UNDATION 2ND [ ] INSULATION [/J' FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ DATE t//~['~ INSPECTOR +~ INSPECTION [ ] FOUNDATION 1ST [ ]/R~UGH PLBG. [ ]~UNDATION 2ND [ ~ INSULATION ,~[//] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ .~~ DATE INSPECTOR 2'65-1802 BUILDING DEPT. INSPECTION [ ] FRAMING [ '~ [ ] FIREPLAC~,/,~IMNEY DATE INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS PAG=I ~.~)75.1.14 BUREAU OF ELECTRICITY ~ 40 FULTON STREET, NEW YORK, NY 10038 Date?" AUGUST 06,1999 Application No. o, file 17957599/99 N 496671 THIS CERTIFIES THAT PE~IT N0. 24976 only the electrica~ equipment as described below and i~oduced by the applicant named on the above applicaHon number is in the premises of VIRGINIA PRINIPI, LOT g4 SHBLL-FISHEN ROAD, LOT O20.011, SOUTHOLD, NY in the folIowittg location; [] Basement [] ]st FI. [] 2nd FI. G/~/OUT Section079 lllocI~5 Lot was examined on JULY 29,1999 and found to be in compliance with the National ~lectrical Code. FIXTURE OUTLETS 51 DRYERS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT OTHER SYSTEMS NO. OF FEET E R V I C 2/0 1 2/0 OTHER APPARATUS: PADDLE FAN-1 WIRLPOOL BATH- 1 WELL PUMP- 1 ELEC. WATER HEATERS, :1-4.5 K.W. G.F.C.I:-IO SHOKE DETECTOR: *'6 EDWARD GARBOWSKI ELECTRIC PO BOX 347' EAST H~.~TON, NY, 11937 LIC. #4574-E GENERAL MANAGER lhis certificate must not be altered In any manner; return to the office of the Board if incorrect. Inspectors may be ic~tified by their credentials. COPY FOR BUILDING DEPARTMENT. THiS COPY OF CERTFCATE MUST NOT BE ALTERED IN ANY MANNER. JU3ITF/T. TERRY TOWN CLERK '[own t~all, 53095 Mare Road P.O. Box [ Soulhold, New York [1971 Fax (516) 765-1823 Telephone (5161 765- I ~01 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION 1/I/AS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town two (2) new forms to be used under the Flood of the Code of the Town of Southold: "Floodplain Application" [FDP(93)], and "Certificate of Compliance Special Flood Hazard Area [C/C(93)]. of Southold hereby adopts Damage Prevent regulations Development Permit for Development in Southold Town Clerk August 25, 1993 APPLICATION PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT tO read and si~n): t.. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO . THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE. SECTION 2: PROPOSED DEVELOPMENT (To be comvleted by APPLICANT) NAME ADDRESS APPLICANT TELEPHONE BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION PAGE 2 OF ,I DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE F1 New Struetmre [] Addition [] Alteration [] Relocation [] Demolition [] Replacement [] Residential (1-4 Family) [] Residential (More than 4 Family) [] Non-residential (Floodproo£mg7 [] Yes) [] Combined Use (Residential & Commercial) [] Manufactured (Mobile) Home (In Manu- factured Home Park? [] Yes) ESTIMATED COST OF PROJECT $ B. OTHER DEVELOPMENT ACTIVITIES: [] Fill [] Mb'ting [] Drilling [] Grading [] Excavation (Except for Structural Development Checked Above) [] Watercourse Alteration (Including Dredging and Channel Modifications) [] Drainage Improvements (including Culvert Work) [] Road, Stree~t or Bridge Construction [] Subdivision (New or Expansion) [] Individual Water or Sewer System [] Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3: FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: [] Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). [] Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) [] Unavailable [] The proposed development is located in a floodway. FBFM Panel No. Dated [] See Section 4 for additional instructions. SIGNED DATE APPLICATION PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: [] A site plan showing the location of ail existing structures, water bodies, adjgcent roads, lot dimensions and proposed development. Fl Development plans, drawn to scale, and specifications, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materlais used below the first floor, details of floodproofing of utilities located below the first floor and details of enclosures below the first floor. Also, Subdivision or other development plans (I[ the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). [] Plans showing the extent of watercourse relocation and/or landform aiterations. [] Top of new fall elevation n. NGVD(MS~. Floodproofing protection level (non-residentiai only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in ~ increase in the height of the 100*year flood. A copy of afl data and calculations supporting this t?mding must also be submitted· [] Other: SECTION $: PERMIT DETERMINATION (To be completed bY LOC. AL ADMINISTRATOR) I have determined that the proposed activity: A. [] Is B. [] Is not in conformance with provisions of Local Law # ,19 attached to and made part of this permit. · The permit is issued subject to the conditions SIGNED , DATE ~If BOX A is checke~d, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checke~d, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPEALS: Appealed to Board of Appeals? El Yes rn No Hearing date: Appeals Board Decision --- Approved? [] Yes Conditions. [] No APPLICATION PAGE 4 OF 4 SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Comifflance .is issued) The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. Actual (As-Built) Elevation of the top of the lowest floor, indudlng basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: Fr. NOVD (MSL). 2. Actual (As-Built) Elevation of floodproof'mg protection is Fl'. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. ~ECTION 7: COMPLIANCE ACTION (To be comrileted bv LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete tiffs section ns applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? [] YES [] NO DATE BY DEFICIENCIES? [] YES E1 NO DATE BY DEFICIENCIES? [] YES [] NO ~ECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR'~ Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING [] EXISTING BUILDING [] VACANT LAND 'DIE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19,, . SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # .... , 19__, AS MODIFIED BY VARIANCE #.. DATED ' SIGNED: DATED: C/C(93) FORt4 NO~ TO~FN OF BUIIJIIN(~ IIEPARTNENT TO~ HALL SOUTIIOLD, N.Y. 1197 I TEL= 765-1802 .... ..... ~..~ ........ .~fi~.~., ~o.F~ ~ ~ ............. ~im~l a]c .................................. APPLICATION FOR BUILDIHO PERN[T a. 3his application must h~ completely filled in ~ ~lter or in ink a~ ~i[~ to ~ h~ildi~ Ins~tor vl 3 ~ts o~ plus, ac~rate ploc pl~ to ~ale. F~ ~co~i~ to ~le. str~s or areas, ~ glvi~ a ~tail~ ~ripti~ of l~t of pr~r~ ~t ~ dr~ ~ t~ dln~ ~lid~ is ~rt o[ this a~llcati~. I~dati~s~ for tim ~stn~ti~ o[ hdldi~s, ~iti~s or alterari~s, or lot r~oval or ~llti~ as ~rein State ~tl~r a~plicant is ovmer, lessee, agent, architect, ehgineer, general contractor, electrician, plmi~er or Imilder ~ of ~ o~ ~,,~, .(?.l.c%c...~,~.~.~. ............................... : .................................... (as on the taxl-~l or latest deed) It app[icfmt is a corporation, signature o[ ~h~ly mltborlr~l officer. (Nmme and title of corporate oEficer) Iq,OT I) fAGIIAH Not.., y PubIic. Stme O, New Yo~k Comm)ssion ~xpiras ~,A~ 22, 19 ~