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HomeMy WebLinkAbout19998-z FORM NO. 4 TOWN OF SOUTHOLD BOILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20607 Date MARCH 23, 1992 THIS CERTIFIES that the building POOL FENCE, DECK Location of Property 165 THE STRAND EAST MARION, NY House No. Street Hamlet County Tax Map No. 1000 Section 32 Block 2 Lot 9Q Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 28, 1991 pursuant to which Building Permit No. 19998-Z dated JULY 2, 1991 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 AN IN-GROUND POOL FENCE AND DECK AS APPLIED FOR. The certificate is issued to EDWIN H. HUDSON & WIFE (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NjA UNDERWRITERS CERTIFICATE NO. N 204638 SEPTEMBER 23, 1991 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 IfOEM NO. 8 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 a 19 9 9 6 Z Date ...................:z................, 19.c).a. ' Permission is hereby granted ta; .......:................~~-s~: Ps...,~.~.:...... ......."~i ~.~..5..~~! ~ ....~.....~..:`.~..,....1..L.9.~.J.. to ~::..a-i~........P.~;...~~.:¢..-.~.,.~:..~Q.....,~..~..... k Q:°.....'.7k ..................r................ V V g~ ~ Co S~ ~ s~,Y'~-~Q-~r.~C.... 0.--1_ of premises located at ~.°.}.atdJ'~........... County Tox Mop No. 1000 Section .....Q.°ak......... Black ...Q .~-:a........ Lot No...~ pursuant to application doted pp by 19.~.~.. and a roved the Buildings Inspector. Fee S~ u ding Inspector Rev. 6/30/80 ~y Form No. 6 1 TOWN OF SOUTllOLD i:: i BUILDING DEPARTMENT !?5;; ~R~ ~ 31~~~ TOWN HALL j~1 y 765-1802 ~ ,~Y'U?%~?~,~1 , ~ APPLICATION FOR CERTIFICATE OP "OCCUPANCY 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 Pire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 17 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. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of~Occupancy - Residenti~ajl $15.00, Commercial $15.00 Date 1./,f1,!?c~,%! ;~2.3....1~.1`~.. New Construction Old Or Pre-existing Building.. . . l~s THE ~ . Location of Property. ,.a7T{c~,f},A~.7).„,.,•.. .....~%~"T~~~~o~~l/~~e~3,, House No.' Street Hamlet Onwer or Owners of Property.~~~!~.~!1i~.~!~;5~,,,,/7,UDc5o/(/ County Tax Map No 1000, Section., 3, 8,,;,,,,,B1ock..~,.........Lot.../„~,,,,,,,,,,,,,, Subdivision..~~C /,~~!E %3e`AcH.. ~AR!N,$ Filed Map ............Lot.. Permit No..~ ~ ~~.Date Of Permit ................Applicant............................. }Icalth Dept. Approval ..........................Underwriters Approval........................, Planning Board Approval Request for: Temporary Certificate........... final Certicate........... r O~ Pee Submitted• X ~a ~ C'~APP ICANe~~i ~~~p~ INSPECTORS Victor Lessard J; i'3/, Principal Building Inspector ~y;~ 3 ~~~'~n~ Curtis Horton 1~ r~' r~'!"; SCOTT L. HARRIS, Supervisor Senior Building Inspector ~ ~ t"~ ~ ,yu;~, o. Southold Town Hall Thomas Fisher ,v ; ~ ~.a- ~ P.O. Box 1179, 53095 Main Road Building Inspector ' i~.~ : fi'r' . Southold, New York 11971 Gary Fish ~ z'x mti~~ y Fax (516) 765-1823 Building Inspectrn Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher )~j~ ~ ~i~~ Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR /`P/~~ ~ ~ Telephone (516) 765-1802 TOWN OF SOUTHOLD ~ ~ j~ ~<~/i'~ A4ARCH 20, 1992 j~) ry l~-'7 r ylq~r~L- ? / SOUTHOLD POOLS, INC. ~y/f ~~h'~~,~~ BOX 539 SOUTHOLD, NY 11971 RE: EDWIN HUDSON To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XXX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XXx The check is ~i~~~X~~(not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 19998-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. CC: EDWIN HUDSON e.. a-+.~ . ~ a_ THE MAW Y!!RK BE?l~7 ENS ~ . UM~~ ~~l5 ' = 1x007.093 ¦NNtAY ~ ~ SEP"I'RHBRH),3,79SI N ),OAF,.R DaM AptNcatiow IMo. on fW _ - ' TNT CRflTIMRif T141T w~~tyiA..feN+w+wwi~wowt.i.at8.as.~...wd iwarie.~bJ'Wyy~ww.+4M.u?wta~lir!l4~Mo wrMNNwt,r..i.. ira tA.r..wt.r.q/.: BDMIN/AASE HIIASON, 165 'CHE ti'i'RANA, F,AS'C FCARL~iN, N.Y. iir~., nn ' OiIT k tA. fouaeiwf ~Sert"k!'t6'R,~'1S~S'Rr49 ~ tat F!. ~ !nd FI. Swre+r5? Hoak Lot ' vtwesuwiwtd ow - and fowwd dr kr lw cMnpli~wce rrltA Y{~e re~i'wgfwp~ Nits Agwrd. - _ otw~e w+t. c. w. a w. ~ r~r. i.w. u~+t. w r - 7 i I-I1-- L__1 # .e~.~f f„RWL! RIO'?Mi titw..wu~ta RRaRa: " I oRRMRRR 1WT. R. W, pl 1A t. OM N.I. 4M. w0. W.O. AMT. Mr 4w. w~ lit: - I. 1. MtT. ' WA17t 7 l0 7 4O = s fMIRCR ~ NO•QK f R R Y 1 Q~ ~ i1wT. AW. T'l1E II iV/ 117w i,a TV i/IN w0.0P IlFlia ~.a~lb Of 'w ~ ONRa r~wa vF. SWIMMING P(H7L-1 F:F:f,F;P'PACI,F;S-1 /G,1' . C. J . - i POOL, iTlti[NG-9: *(SN:f)7MING POOL) '3'his certificate covers rn®pliance at the date of inspection only. Hecause of unusual envi.ronmants it i,s advisable to have frequent test andJor rapairs made by a qua7.i.#..ed person. / .Pb'l t~- <<< Continued on }'alJe 2 >ii RR? fMIA~1fORCe,R Fer, Gy M?.«, wiru a??.kcplMnt~ in aw~,w# M, ~R A.I+,M. raaa. s . .fir ~ri? "M'• ,`A. ~ . a-..- ~ Y, 1601.09.3 i14ifW?U ITI~ t ,per srlwtr. n~w~ r~l~ jp~~° f- SEPTENHF,R 23,47 t.i 39 31 N )(trlfi`iK ' Opp Aplicatkwt. No. alfik ` TNIi CtiFTMhii. TMAT .wy Mo oMeniertMttyrraw~f a..e.ik.a kdrr owd iwt.ait.cw b w r/+h.Me w..u+.w ek..koe..Mw.a.w wY..k.. ka tkapawJw q/ r EAi(7NJAAS75 H17DSON, 155 TN`r. S'PRANi), BAS'[' MARION, _N. Y. QU'f in /ksfotlowiwR fae~. .~~i(1'E![lSr~9.~ 1•e Fl. ? fnd Fl. S~nRkw Mack Lot .va nrarnlasdan owdJewnJ to ke in cer~N~wee teitktk~rpoit~+d'~it-&o~~rJ. ~ L_- M~M- f or~o ,wr. aw, 4nr. cw.- _ wwT. R-w. ter. ~ r s ~ MY~f - MOtAi1f !/IYAI14f I~f 011AIAfwf - ,wr. R. w. ox e. r. ws N. r. wtr. .xS. A w. o. Iwr. Mt?. kNr;: EMI. +M( ~ k 1wr. wwrh ! a f t it Y 6 At, a. _ _ _ _ Mtt. MV. 11F[ I1 TY 1 /7w i / ]VI ] / N/l NO. rKL Qr /?yp /b. p MUrtAIS ~ - ~ ~ a onlw >ruk ,F ' ~A GARY DOR(1SRI LIC.~{),941W 4'1.5 H6NSS1,1, DANE CJUT('HOG11F„ NY, 1 1.935 - ~i - w ~ Ftr~!- , ti . ~:,,W,,.. .v =TEED I;:S:'F.CTiU;J ~IUni ~ i;OMMGNT° - 1. m ~ ~ ~ ' ~ N H FOUIJDATION , (1st) ~ _ ~ c ' FOUNDATIOJJ (2nd) - _ m 2, ~ z o P,OUGH FRAME & ~ •PLUMBING ti 3 . '-3 m m IIJSULATIOhI PER N. Y. y STATE ENERGY CODE g x a 4 . y /9 FI;JAL • o y ADDITIOPIAL COMh1ENTS: m` x • ~ x ~ ~ N ~ H .1J H O 2 ~ }2 A 1. • y T - - M '"d H • 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ }FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: / ~ ` DATE 6 C S INSPECTOR G~~ U 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ~ ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: ' i DATE ~ 2i INSPECTOR .~,a•.m. 1 BOARD OF HEALTH . ~ U~~~w~ 3 SETS OF PLdNS if ~ FORM NO. 1 SURVEY V: K , , , , , , , ~ ~ ~ e ~ ~ TOWN OF SOUTHOLD CHECK ~5,~~,~`, , , , , , , , i v 9 ~ ~l'J BUILDINGDEPARTMENT SEPTIC FORM JU~..v>_._. , a ~,.,;,_"'JJJ TOWN HALL . gt,t}fy.OEa''f. $OUTHOLD, N.Y. 11rJ71 NOTIFY °t TOWN F,SC7oUTN01_X"7 4 TEL.:765~1802 CALL C,;U2l`--?.....7~S.A3r!a~. Examined . Z...., 19 J MAIL- T0: Approved . 1 „ ]9`~ 1 . Permit No..J. 9.4 R Disapproved a/c ................................•••/1~.. a (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 15. INSTRUCTIONS a. Tlus 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 inspections. Sc~ui.l-l~t~..~~~. ~:..~^1~. (Signature of applicant, or name, if a corporation) • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . SEC, r Name of owner of premises ~~4•'!:~ . C ?U=c~. . . (as on the tax roll or latest deed) If applicant is a co oration, signature of duly authorized officer. (Name and title of orate officer) ' Builder's License No . Plumber's License No . . Electrician's License No . . Outer Trade's License No . . 1. Location of land on which proposed work will be done . . I{ouse Number Street, ~ • ' " " " Hamlet ~ y+ County Tax Map No. 1000 Section Block ....G,_-.. , , , , , , , Lot ~f:k: , r , (7• , , , Subdivision ...rte. ~ (`~ZM Filed D1a , , , , . • , , . P"~?.~.:. p No. Lot ......~.f~ (Name) Slate existing use and occupancy of premises and intended use and occupancy of proposed construction: II\\ a. Existing use and occupancy . ~iu{°. I;lkvt;.: ~ ~ .C?ac'`~' = b. Intended use and occupancy ~ • J ~Ra~~ ~1; ~ 'Cl~;.:?l t•..~iC~.r, , . , . . ~ iy S Nature of wort, check which a Re air , , . , • • PPlicable): New E3uilding , , , , Addition Alteration- • P Re oval . . . . . Demolition Other ~1,,, , 4. Estimated Cost . .Fee . .y fJ~~~ c. hption).. ..,r.. " e (to be paid on filing thirapplcahlbn) If dtvellin", number of dwellin units . • , Number of dwelling units on each floor , . , , , , If garage, number of cars • • • • • ~ if business, commercial or mixed occupancy, specify nature and extent of each type of use , , , , • , , , , , • . • • i " g Nu es, if any: Front . Rear . H~mi>Ysions of existin structu~ber of Stories • • Depth Dimensions of same structure with alterations or additions: Front Rear . Depth . Ilcight . . Number of Stories . . Dimensions of entire new const~•iiction: Front . Rear . .Depth ~ • Height Number of Stories . ' . 9. Size of lot: Front ......°~~?:r , Rear i . l0. Date of Purchase l 5~s~ . Depth .~S..S ~ , i Name ofFormcrOwner 1 1. Zone or use district in whic]t premises are situated . , n Fr.~., • ~ • ' • ~ ' ~ • • ' ' ' • ' ' ' ' ' ' ' ' ' ' ' 12. Does proposed construction violate any zoning law, ordinance or regulation: ,N.Q • , • , , , , , , , , , , , , • • • ~ • • • • • ill lot be regraded .!':4~ • P Q • • • • • • • • • • Will exce s Fill be removed from premises: Yes No 14. Name of Owner of remises lz, ' ~-IM~S•t1,~ , , , , , , , ,Address b4" 'irlla Name of Architect " • • .Phone No . • 1 • • • • • Address • .Phone No. . Name of Contractor.~c)U~IQoI Qc.~-•••••••• • • • ....Address ..Phone No. ,/~rK~;Ziti;., IS.Is this property located ~within300 feet of a tidal wetland? *YES.- r}0, , *If yes, Southold Tow Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~inumber or description according to deed, and show street names and indicate whether interior or corner lot. I l STATE OF NEW YORI`, I, COUNTY OF ~'S ~ ' ' ' • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant (1\ame of individual signii1g contract) about named. I Iieisthc (Contractor, agent, corporate officei, etc.) ' • ~ ~ • ' ' ' ' ' of said owner or owners, and is dulyauthorized to perform or have performed the said work and to make and file this application; that all statements contained in tltis application are true to the best of his knowledge and belief; and that the work will be performed in the manner $ct forth in fire application filed therewith. Sworn to before me this .day of.~!, \ Notary Public, , , ~dee-?mac ; , ~/V e- County ENKOEYOE I MOIARY~BL~~,.,ShotNew (Signature of applicant) Tem ~E4xgi~TMeroSohtoNc CIsu~3 r_. 4Ti , IR ~ A I' la` <ie_ ~T-t f ~ik1~~3" 4~ ~j finePyAl. N:kl~~Y2681'~.~ ~ _ ~t ~yl~~ s n _5 I Mx3~' T?I ~y~ykF~~ f ~~£v+k o' ~~'T11r1 Si 0k~ " ~I~.'~ ~I ~ & ~'HI ! ~ t ~ .~THfRE ARC NO DWELL/NG {y/TH/N /00`OFTN/S ~ ~xY~'r~r nn r`~ ~ " ~ ~ ~ ~'attsl~,.*~~r~";' ~ ~ PROP~'R]'}' QTNfR TNkN THQSE SHOWN HEREOiy. J~. ~ d~eF ~ t r ~ a sshr s Y tl ,'I ' lGt ya -f t ~xl~~ wcr ro' @ a t4 {n ~ " 1 ,JJ"~ oo - ~ ~ f /y~ ~y T f S 5~P ~h V~ y~`T~ M+k~ A' p ~ 4' f~, fig I' ~ yY 1 nx ~ ieA, n r r ~~oe~~x A "NF z yF.° ~\t~r a~f t„r~t ~C, - ~%1 I x r~ ~ ti u~r~l~~rp~~r 1 f6 ~4~ t s ~ R~ t" ` 3 "'H l' NM Xk/ _ t t 4~~Ag t . '~"x?yq sn81 ,t~>r"' i C1! ~t ~ ~ f ~ a 1' I u '~1p N r~~ ~ ~}~,~~F°j~, a o 'Fn* ~g"1 ~°yl+`fC`i ` ~ i a d .ply ~ .'~tT~} Ihn~~wt T~~t ~ wD~~wi,y ~ t'~T, ~ T~ al - TeFf n ~~1°~, {S ~ F - it fIF'y~ `~:p,~1 Jy1'Y 1 Ub! , 1 ~ln.. ~r 1. S , yii'fv~ ~I~'Y'. A ~sY~;'`~hyi~,~~~ S~p~, 4~'',v""~'t+~, *~'k~ i~a~ ` ~~4 n -nYd ~ 4° .i 'fi 7 p r i I vs g: h a' a6 ~l ~ ~A i T , I t4 ~ x~ u^ M, x~~to"Tt 4," r 'pa ~ ~ 1 \~j~ , .~'~.~cc,,i~~'~ 4~,~f: k ~ "<~fl~ "l4~s~ ~ art * ~j ~RSGE i ,#,yyf Y Ykb OI ~Ytu i ~ I~1 Y( 1 1Tr~ ( f~,i fix, ~a". ~ t 9 ~ P ,15 r w- T' 3 f ~tr~~ }~4 ~H,LSIy r d ~ ~ w YC ' ~ ~ti g ~g p~~~]9~ y~ fY'~', Y~f~~~ t~ ~n.. ~ 11 ~ ~ r ,~''°s ryl~ ~ ~ kt v A ` U~~ d~ ~Ii ~RCtl0 S~47~ s „ e ~ ~ o i r Iti,~ ~~3 a"`~~ ,4, ~dB7Ht3d~~" ~ERTIFICAi'E f , ~ 9~~ ` ~ ~~~~o~~p ~s a®r~~ ~ OF QCCilPAWCY , q t~~ ~ 1 : a,' ~,;a ~I yr r Iwt ~~~.yl ' ~~~~*.s ~.~'OTFp3lLD G ,O~PQf?TttrlE -%°;a 'k ~ K ,1',~~ ;7b~a t~C53=~ ~141'fC) m P~'~ FUR tH ~ ~ ~ ~ h ' ~'7TT ~~t ~4§'`r' `y"*CjLi,.4i.Atdl'+l~i !N ~PECaI£}EV:4. , t I+Y v fir' ~ 1 1i,. ~UU~3DAitOPS' TWU REC2UlRE~Y . ` s ~ ~ ~At ~ ~D FbFt Pg4IRkC CUNCREl"E f=R,~.MlNG Ra ~~-UM8lNG ~ ' ~ ~ ~1 ~CJUGM ~ m v ~ AfBAR~`~~ ~~I i o ,~~,,lN?3utAtlOtJ PG+ I r pe k } T p' CQIV~~TRUCT!©N MtJS~ Jt ~ 1x1 Va~"~ ~4YIt'.~S t'{.~"~„~ TY~~~T bl ~ ~ F~Ni~"~r~ ~ :~~~Yi s ~ s k a ~ R~ CUMPLETE FUR C.U. , .t. _ ~ : r> '^~1 ~4jll j', Y ~~d y ~ ~ti°r'1` ~-,a~~~_.caN~'ri~u~'!aN- sWau MEE~r ~ ,>::.e ~ti~K'~n 4i ~Ca f'n'41 REQUlREMENYS OF TWE N.Y, "'*a ~ n ; ~ Y "I~. , r, ~T~A'tE NUCTlUN $ ENERGY N ~"I E OF o a~ r.~D1S4S. NUl' RESPONSIBLE FOR S k, ` Y~ . °p~31GN OR CUNSTRUC7lON (cRRURS . SqP d'p D W. M ~r~*+ I~rl ~~p o~,P~` ,.,.roG r ~ g~'Pz~b;.~ .1 f ~ 4 I a s r Y ~ p 1 M' r ~ ~ ~ , . >~P ~ ~ ~Ff %889,'' i. _ , fHE QFFI~E - ~ _ , ;GpUNTY 9N ~ " „ RF~XJ~lA~ s2~~ ~ x ~.-Y.. P~Q & YOUNG - ~ ~ ;q{AR•;~8, ~,~~f ~ ~}QO QSTRAN 'R A~ENU~, RIVE (tHFAD, NCW YORK ' ~ - _ Q~'-'plrp,~'{p3d'~1~p~i~-' ,AI.R~~N W. YOUNG HowARP W. Yourvc ' /A+[v~~~1S!~ ~R¢F~S¢IQNA,!- ~IIG INS AND ~aND SUPVEYOa ' ~~G ~ k~2lyGl Sl~PY~rgP. fi.p's.~yG. Tfo. Izea¢ N Y.s LIC~NO. a~es3 , ~ I ~tlRyEY F~Ri uyaUinoR21.R. A4iERATIRNQpaAI RAPiiIGy TR ,t+'~ p~ ' 1209 OP TH¢ INf W'YDRk &tAT ~~FGU9a IRN ~ k4 ~ f k=~~~IV ~~~`-iQ~ V1 f'i Y"!`7 ~~~`7~~ ' : ` , h~T~76. !lP~~BLE ~EAcH FARMS° CGP@tl 9F T106 3GNVEY MAF y0T REANINO. , tH€ ).aND 9VNYE y0R~8 INNflA pCal PR ~ x h' EMBUSSf9 BCg4 $IIa1L Np1.pR fONStpf RfD ~ t _ _ - - - 10 BA A YAUGIfRUE. fGPY AT ~ GUA RANT EEU TO: ~ 'BAST' ~MAR10?y cmcaca Tirt_E msuRnNCe co. ~aRaN IEE: INRIOa1t41 Ip R!(jN 4NAl.I Hlly , ro n¢ a .cr Fn pnam Inr TQN/N OF Q(~ ' ,a l;Y IS ngA(aRfO AyiS by. FSTa Ot gAIE I ~ t!4U~H~Lr 4! ~u _ _ IPf -I Om FgNV 0@VFryNMfN lAI r v:NM 4NG 1@Nn ld ,N liFI IV IM II YFII, t~ - ' T- T-~ Q`/ Ru+eou rno w NCa IArvtG De ulf SUFFO~-K CO., N. Y. p~~/~~~ Fbf NU Nzi r TIGI r ayY ov( ARP art umr .s ruR t c aar lT ~,NnI r SCAl,~ n ) GATE: NO uN e+/ysbN0~1r,9w.NY s °.,$A? ~~,.t ~.a,,.'~~' (,1GT. 2Al 1976 76-919