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HomeMy WebLinkAbout19185-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20067 Date JULY 11, 1991 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 1895 MARY`S ROAD MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 139 Block 4 Lot 2.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application far Buildinq Permit heretofore filed in this office dated JULY 11, 1990 pursuant to which Building Permit No. 14185-Z dated JULY 11 1490 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 BREEZEWAY & ATTACHED TWO CAR GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING & ALTERATION TO COVERT EXISTING GARAGE TO A BEDROOM. The certificate is issued to RICHARD & MARGARET MUNCH (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-158255 - OCTOBER 31 1490 PLUMBERS CERTIFICATION DATED N/A Bu g Inspector Rev. 1/81 ~S~ Ho. 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 o { ~ ~ ~ ~ Z Date ~ ....1/ 19.4..Q Permission is hereby gro to: . 14:,,.. ~'.....L?rf~: .........................~.p................................,....................................... a premises located ot .l..u~.4..ti~i......~..~!!!-~.....C~,d:......~..1:5: County Tox Map No. 1000 Section ....f..,3.9.......... Block Lot No....~.e.I........... pursuant to application dated .........~....~t' 19.9l~.,, and approved by the Building Inspector, r r Fee S.. S'.c ~!~~r Bw ding Inspector Rev. 6/30/80 _ F~^I Porm No. G N ~ ~ / ( j j 's/f/ TO~JN OF SOUTIIOLD BUILDING DI:PAIZTiiGNT TOWN BALL ~ i~~`" ybs-laoz - 91991 f,... l ~~ArPLICATloN FGR c>iRTZr•1cnT>: or'occur~Nc j[fyeriEi: ,,-.r , i This application must be filled in by typecariter OR pink and'submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate to cation of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval Erom Health Dept, of water supply and sewerage-disposal(S-O 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 C~;mpliance from archi-ect or engineer responsible for the building. 6, Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property sho~,rin;, 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 Guilding Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25,00, Additions to dwelling $25.00, Alterations to dwelling 525,00, Swimming pool 525.00, Accessory building $25.00, Additions to accessory buildinb $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 - Residential $15.00, Commercial $15.00 Date 09/ ew Construction........... Old Or Pre-existing Building ocation of Property..l89~.........1`.'iAr~s.. ~?Q.e~ MQ~,~;i.~z-!C~c............... House No, Street Hamlet ewer or Owners of Property.~~r~~?.~:.~ .~1!~.d..~~C~qY~..}N,.1`!1,4~}?~.~1 ,unty Tax Afap No 1000, section.J~~L......,,Bioctc...:(.. .......Lot,..z f :bdivision ..............................pp......riled PYnp,...........Lot....................., rmit No..fiq~g5, z". ....Date Of Permit.~li~.~.tf.Jt.,.,..,Applicant.(S.Y;t/.Y,Z/.Q .3 alth Dept. Approval ..........................Underwriters Approval.? „ cnnins Board Approval quest for: Temporary Certificate........... Final Curticate.~........ Submitted: $~~:~4n..... ~'~~`(ai~s . _ ;-S:rt.rArs.n~,sty.RJArPgc.~rrT~;`r':?vC~J"~ C.c1 :1.. a C1tRu'1 c1ELD I;:S:'EC:iU;7 ~~UA:c ~ COMMENTS - .9 ~ m _ ~ ~onG y FOUNDATION (1st) a FOUNDATION) (2nd) n/ m • _ ~ C 2 . `oiY a z o P ~ 1 ~ P.OUGH FRAME & • Ye Q; .PLUMBING N ~F 3. m m ' H ZIJSULATIOPI PER N. Y. STATE ENERGY CODE m } a . y ~ 3u~s=P- ,-.I y FINAL . 7i C,.© ° ' `z ^ ADDITIOPiAL COMMENTS: ~ ~ J J !1. _ ~4, x ~ ~ ' C.W ~ ~ z m y ~ H o r, z '1_ . z m a • r _ H S d m w H I ~ THE NEW YORK BQA1A~ ~F ~ UNR"~t~~S Nnc,r; 1 ;.001071. if6 JOHN S e~~'T~NtW Y~~~~y YfNIK 10036 } ~ Mk SLILY jl, i 9!i1 fi3414R91 /97 H 196908 Applketien Ns. ortpk _ THIS CfiRlTIIIEfi THAT _ only tM daetrbel agwlrmsat a dreri6sd 6deto end inttabeei~ky tIM aM/4atr~t wMwd en tMaMtt?~eatYttaewtkw ks QMprwtLaa ul ~ Rf,CHARR HUNCH, 1.895 MARY'S ROAD, MAT9'1'CIJf,K, N.Y. in tka foNowiaR J[}~;Y ~ 9wtsent Ll !At Fl. ? fnd fl. 3ertfon perk Lot Jlli 1Y91 aros examined on and found to M in rotwpAenre Mvtk tke reVelroetanM of Lkb Z extuRf ~~~f AQif NfANOlfttMT R{IO~f/CL/T OTNM IIAT.. W. ,AM1. C. W. AMT. A.W. K w. .AMT. N. 1. 5 3 ORYRRS 1{IDUp MD7{iRS lWItM M111M1q MIE71` 1t~.. ft1LL tI1M? OIMApRi. AMr. t. w. at N, r. OA.t N. r. AMr. np. w w. o. -AMT. AMt. AMi. AMK FMNf. AMT. M• r. AMr. wArn fRRWO /IfCOfRIKT MR:Or f ~ R V 1~ C R ~ AMT. AW. Te[ t~YW 1R3W i,I iW tq fW « N[A.a MFUO MO.a11YICA17 M W. E A Oflllf A/MfATUf: RL1:C, ROOM HEATI:RS:1.-,75 K.W.,i i..7,5 K.W. sMOK}: AFTF,r_TOR:-1 `i 4 - G & S C.ON~'RnC'tOR W I,[C',#57$-1; - BOX 275 SOUTHOI~11, NY, 1.1.97; 11 ~l Ptr_~]r th. atut} .al b. aM.t.d M etaanatF morn ki tM a(Na d - ? ' * - _ - _ _ ~ ` ~p ' onw~TwMT. Tws c~orlr a~ eMgerA ' rl®R MI6 r~> - - - THE NEW YORK BOARD OF FIRE UNDERWRITERS pArr>r ] 100107]. BUREAU OF ELEGTRIGT'TY SS JOHN STREET, NEW YORK, NEW YORK 10038 ; - Data OCTOBF,R 31, 1990 Applieotion No. on file 70991690/90 N 158255 THIS CERTIFIES THAT only the electr&al equipment w dsecribed heloEe and introduced hY the opp/icent named ort the chose appBeation numMr in thepnmisu of RICHARD NUNCN, 1895 NARYS ROAR, NATTITUCK, N. Y. in thefolbtcing bcetion; ? Reesman[ ? let Fl. ? Ynd F1. GAR/ATTIC/OIIT Section Block Lot - maa examined un OCTOBER 22 , 1.990 and found w he in compliance with the reyuirementa of thu Board. NKTWE _ RXTURIS RANaf COOKING DECKf OVHif DKM W_- _ IXNAYfT FANf OUTLETS AtX6 SWITCHES INCANDESCENT PlUORESClNT OTHER AML. R.W. NAT. K.W. AMT. R.W AMT. R W NAT M. P. y a o 7 a DRYERS RJRNAGE MOTORS 111TUR! AMtIANCE IBRERS SHOAL REC'?T TIAY CIOCIIf ENL UNIT IYATRf AKNfl.Gt/itEf DIMMERS AMi. K. W. ql N. P. GAS N. P. AMT. Np. A. W.O. AMT. AML. AMT. AMPS. TRANS. AMT. N. P. a ~T AMf. WATiS SERVICE DISCONNECT tq. OF S E R V 1 C AM1. AMP. TTPE 1 / ]`N 1 / SW ] / TS' 3 / IW NO. OF CG COND. A. W. G. NO. a: H4lEG A. W.G. ND O NENRAlS A W, G. EOOB. PER! OF CC. COND. _ OI N4~_- OF mDiUl _ _ OTHER AMMRATUS: - C,ARAGE HIRING: ONLY-1 G.F.C.I:-1 ~o~ ` G & S CONTRACTOR LIC.if578E bOX 215 SOIITNOI,D, NY, 11.971 9Ef1~M RRM/119ER 1.1 Per Thit certificate must not be akersd in any manrror; return to the offies of the Board if incorncf. In s_m4y 1M i+fltliN~d h~_their cTadeMialt. I COPY FOR BWLDING DEPARTMLtNT. THIS COPY OF CERTIFICATE ANJST NOT R`[. ALTS IN t1MY MAMIER. n. •4d` R ~ ~'y" 7i8-iN2 1 BUILDING DEPT. INSPECTiOi~! [ ]FOUNDATION 18T [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ] INBULATION h [ ]FRAMING [ ]FINAL REMARKS: ~ ~z~~ , , > ~ '1 ~ i DATE ~ IN8PECTOR ~ ~ ~ ~ ` Form No. 6 TOWN OF 50UTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 !i . APPLICATION FOR CERTIFICATE OF OCCUPANCY .1. 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-4 form}. 3. Approval 'of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying thaC the solder used in system contains ~ less than 2110 of 17 lead. ` S. 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 Inspoctor 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, Accessary 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. Upuated Certificate of Occupancy - $50.00 S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ::ew Construction........... Old Or Pre-existing Building r Location of Property House No. StrBet Hamlet Onwer or Owners of Property County 'fax Map No 1000, Section.....,.........Block ................Lot...................... Subdivision ....................................Filed Map............Lot.......... Permit No ................Date Of Permit................Applicant............................. Health Dept. Approval ..........................Underwriters Approval........................~ • ~ ; . Planning Board Approval Request for: Temporary Certificate........... Final Certicate........... , Fee Submitted: $ • • •q.• • . ' ~ APPLICANT \ 1 ~ {T, n ~ ~ ~ ~"V i' ~ ~7 ~ ~ i tr ~ - ~ ' I ~s.n..~t) « O n, _ _ Yl? .c' y7. Z5 ICS _ I O T. ~ t`- Cht, . T: 1~ ' v t ~ I STCYR.Y ~ ~ ^ ,t 1 \ - t ( - ~ i t Q ` t ~{GHCG~ ' o Z• n nom' - ~ S ^ 1 4 ~ U 0 n' ^ ~a n V r. 1 ~ ' C^ i. ~y ~ ~ ^ s ~ m ~ C ] p Y yAl C ~ ' F ~ a G;X~~ .i 3 ' q~ ~ i ~ 1 ~ \ y.<~nl a ~ z ~ ~ ii l 1~ ~ o° is ~ R2?'44: ~ qW. 4. ~ 0~fl4S~~~y'•~ ran t • y~Y~• O %~r3 p • O' I~~ ? J C m~ 4R n'ra S :i K.=~ ~ ~ s o ~ d 765-1802 BUILDING DEPT. ~ NsPEcTeoN [ ]FOUNDATION 1ST [ ] ROUGH PLBG. ]FOUNDATION ZND [ ]INSULATION [ ]FRAMING ~ FINAL REMARKS: ~',vvLC-¢!Yi ~.ac=Piz-rl~t~ a.~~ fli ~7-a DATE `Y ~ ~ °I- ~ INSPECTOR ~ U• L.. i w S ~.-...-.a.. ~ _ ~ - - ~T ~ 'I' i"Iii ~i - , i - ~ ~ ~ ~ { I ~~t _ ~ ~ ~ , , _ - _ ~ i i . - ~my, II i ~ j~ I ) S c I I ~ Cr a-~ ~ i _ I 4-_ ~ ~ ~ ~ I - _ _ ~ _ ~ i I 1 ~ W ~ ~ I ~ ~ i~ N _ 9 i ~ ~ _ _ -~~~~---~-j ~ a ~ I ~ ~ ~ IS f~ o' _ ~_A - 'I -0 ~ ~ ~ i i j. ~ ~ jti ~ ~ 'I ~ ~ ~i~~i j ~i . i I f ~ - ~ ~ i ~ x - - ~ ~ ~ ~ i ~ ~ v ~ ~ - - i ~ ~ ,i iR ' . ~ i ' { I ~ ~ _,__,_.r ~ o _ ~ ~ x { ~ ti s {'>.r r` 1 N ry ~ P ry x fi h N i a L ~ # ~-J s i~ , 1 ~ . /S ri „ i T` _ - - 1-; r - i ~ 'i ~ ~ ~ i' \ N; - ~ I ~r'J 5,,~~ ~ ~ it ~i ~ , - ~ I I ~9 I i ~ I~iI ~ s I - _ _ ~yl i ~ ~ I i i y I~ i I is to ~ P r~~- ~ ~ i ~ ~ j ~ ~ ' S T ~.a ' '~J ee ~ ~ I ~r, ~ ~ ~ ~ _ _ ~ i~ I A ~ ~ S ~a-s>---- ~ ~ ~ ~~I ! { I 11' ' ' ~ ~ _ i~~ i i i I~ ~ i7~ ~ ' ~ i ~ ~ ~ ~ i 1 iii ~1 ~ I~iu ;li~ 3 ~ I' ~ ~ ~ ~ ~ ~ t ~ 9 ~ ; ~I ~ ~ ~ ~I a I ~ ~ ~ ~ ~ ~i py 7~3 S i I i i III 1 - _ - . _ ~ ~ I ~ i , 1 X 1!i 1 ~ ~ ~ ~r i.'I z. - ms's' ~ ~ ~s p o o 1 ~ i ~a y1~ 5 ni ± 1 i 'I }s n ~ ~I ~ t t O 6 I ~ ~ ~ - ~ _ ti9 ! ~ t~ . ~ ~ .I I 1 i "~q (.'tl `r' 4Y - ~ 1 e ~ ~ ' I .~,o~ - - 2.t~ d .j ~ i o~ . _ a -tea r ~a - ~ "i j ~ o a W ~ ~ ~ 0 4 ~ ~ ~ 14 ~ ~ ~ r , , - 1 i I ' ~ sao~aa N0i1711!lt3N0~ ~b Nhi5~tl x ~ , ~ tii Qi 316~SNOd33a 1AN ~53UUJ 7 ~ _ ~ o~ ~ ~ E ~~aaN~ Nouana:tsNa~ al~is :l'N 3H1 ~0 S1N3W3tl1t1U9t1 3H1 ' ~ ~33W 1wHS NGtt~na.tsn~a~ i~~ _ O'9 tlUd 313"td+IVtJ:1 3f.Y ~ pt~' ~ _ f %~_~~I_ " ~ LSfIW NOt,L3(1!l19N0~ l.7ids:± T~ i ~ ~ t`; ~Cxi~ttlttgi\Ii E l ! ~ JNfBWfl~d '8 ~n+tV~t~tt:s t !;t+ Z. YJ"~ . i 'or ~ ~ rs~ - ~ 4 U3>,9M11~~>jOrtns ,wr,(i3 t 'f} ~ ~ IS ~r'.~ ~ ; ~ ~ ~ 3t ~r~L ~ ~ ~ t;3i ~ ~ ~ ~ 'W f ! i ~ ~ 3Hl 6C7~ dr3 v e. r ~ ('t ttr .51. ~ ' P ~ ~ " ! 1 1, tt' dN3aV.G:tr7tra'dU e~tltt ~r' <a Ai 1L7,1) ~ ~ us ~ of I ~ ~ $ X48 # d to L, ~abca 3lJ I it ~I ,'i ~,q ~ j ~ i f ~ i ~ ~ ~ ~ i' ~ ~ ~ t i ~ 'C,3 ~ 1 iii ~ _ ~j= ' i~~ ~ ~ v ' ~ I Y Y J1 ~ C~a r- ~ I. 7 ~ I f Qh S „ ~4~~? _ ? , ~ I ~ 1 ( 3, c! I ~~t;~~ , s i< i ~ ~ , ~ , ' ; ? ~v 3 ~ ~ ~ to w ~ ~ r' ,y ~ f i r ~ ~ ~~I I' ~~G.i ~ u ~ c~ ~ a d ~ , B0.\RD OF HEALTH.•.••••.•.,•. 3 SETS OF PL.\NS FORM NO.t SURVEY y~ TOWN OF SOUTHOLD CHECK ~U~ { (IAII BUILDING DEPARTMENT SEPTIC r•oRCt TOWN HALL et,~, OED $OUTHOLD, N.Y. i1~J71 NOTIFY o 70WN 4t0UTHOl.D TEL.: 7651802 CALL . . . Exantincd~.. t(...., 199. MAIL T0..... • • , • , , . APProved .t.l...., 194d. Pcnnit No. j~~'~~1., . Disapproved a/c . (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date ~CS~A{.I1.........., 15o1Q. INSTRUCTIONS (f d a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with $ sets of plans, accurate plot plan tlrscale, 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 perrnit shat! 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 FIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Quilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Rcculations, for the construction of buildings, additions or alterations, or for removal or demo]ition, 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 buildin; for necessary inspections. , (Signature of applicant, or name, if a corporatton) _ ,1$95. ~-o~.cU.:>.'?tiq%i~tu:C~, .?l-: ( ailing address of applicant) I } qSa State whether applicant is owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....O:c.t~1"1RJ.~ Vame of owner of premises . ~.~;.~"4CtllR)J 'S~/Y\R~'.. ~x~:~..Q:.~~?a~f~U . (as on the tax roll or latest deed) C applicant is a corporation, signature of duly authorized officer. (Name and title of cotporate officer) • Builder's License No, . Plumber's License No . . Electrician's License No . . ' Outer Trade's License No . . Location of land on which proposed work wilt be done; (louse Number Street Hamlet County Tax \1ap No. 1000 Section . ~ Block , , , , , , , , , , , , , , , , Lot . Z•,I.... , '%J Subdivision Filed Afap No. Lot . ~(Namej ~ . • State existing use and occupancy of premises~~,,a,n,,,,d,,,,,,in^^t'ended use and occupancy of proposed construction: . A. Existing use and occupancy.rt:~::::'~•••• , • F '.dF+i~ B. Intended use and occupancy..~.~A,t1lS. 3. Nature'of work (check which applicable); New Building • . .Addition .t~ltcration 1 . Repair Removal Demolition ..............5 n^> pool............. Tennis Court Acrressory Building..........Fehce ii erfv. ! . i. Estimated Cost .~/m ~4yA Fee . . (to be paid n fili this applications , i. If dwelling, nutnbcr of dwelling units Number of dwelling units on cac "floor ! . . If arage, number of cars ~ if business. commercial or mixed o . ccupancy, specify nature and extent of each type of use . 7. Dimensions of existing structures, i~' any: Front . Rear Depth . . Hcicltt Number of Stories . . Dimensions of same structure with alterations or additions: Front Rear Depth ......................'Height ......................Number of Stories . . 3. Dimensions of entire new constnrction: Front Rear Depth Hcigltt Number of Stories . . Size of lot: Front . . Rear Depth 7. Date of Purchase , ..............Name of Farmer Owner 1. Zone or use district in which premises are situated . ocs ro osed construction violate,,. P P o any zoning law, ordinance or regulation : 1. Nameoof Owner of remises , , , ~ ~ ' ' ' ' ' ' ' ' • • • Will excess fill be removed from premises: , Ycs , No . . p .............Address ...................Phony No............... . . Name of Architect .........Address ...................Phone No................ . Name of Contractor , .....Address . .Phone Na.. . S.Is this property loc.~te~id within 300 feet of a tidal wetland? *YGS....NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all btjildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether tterior or corner lot. i - ~,I . STATE or• NEtiv YoRr, s.s :OUNTY OF . ..s oicontract) , (Name of individual si nin~r ~ ~ ~ • • • ~ ~ ~ ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant bove named. fcisthc I ~ ' (Contractor, agent, corporate officer, etc.) ~ ~ ~ ` f said owner or owners, and is duly a~thorizcd to perform or have performed the said work and to make and Gle this PPlication; that all statements contained in this application arc true to the best of his knowledge and belief; and that tt~e rork tvi11 be pcrl'orntcd in the manner set forth in the application filed therewith. r wom to before me this ` pd~a~~y ofq~. 199. ~ lotary Public. C:"~': ~ ~a'~;~:.. County NELEN K. DE VOE y~~J~n~4-fS!~! ~.+~rrri4.~c'..~ NdtpRY PUBtIf, State o1 Ne Yak No. 4767878, 5uffolh Cou ty (Signature of applicant) Term Expires Merch 8U, 19 ;