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HomeMy WebLinkAbout18712-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24147 Date FEBRUARY 1, 1996 THIS CERTIFIES that the building NSW DWELLING Location of Property 235 WICKS ROAD NEW SUFFOLK RY House No. Street Hamlet County Tax Map No. 1000 Section 110 Block 8 Lot 22 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 20, 1989 pursuant to which Building Permit No. 18712-Z dated DECEMBER 28, 1989 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 A ONE FAMILY DWELLING WITH. ATTACHED GARAGE, DECK AND PORCH AS APPLIED FOR. The certificate ie issued to DAVID & DOUGLAS MCGAHAN (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-112 JANUARY 25, 1996 UNDERWRITERS CERTIFICATE NO. N222925 FEBRUARY 3, 1992 PLUMBERS CERTIFICATION DATED MAY 23, 1995 DOIIGLAS MCGAAAN K ilding Iiisp~ctnx--- Rev. 1/81 eoaas xo. 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) No 18712 Z Date . ~~.~........ ~, 19.~~ Permission is hereby granted to: c~ .....G~~l~..'~I . ..r..y.~.-~........r.1.1~.. ~.s ct premises located at .....~r.3~...kU......~4/~•.~ .................................................................. ................................................................................ . County Tox Map No. 1000 Section .........~~Q.... pursuant to application doted ...........~!1/~jA... ...........................~~jj......................................,........... .. Block ...........Q......... Lot No.........1...~'... ........................... 19,..~~1.,, and approved by the Building Inspector. Fee $..,~egk/.~~ ~l~S~lf ~^ i //~uil g Irespecua Rev. 6/30/80 ~~ r y Form Na. 6 it ~~, ~,, r~ TotaN or• souTHOLD } BUILDING llGPARThiHNT TowN HALL ~ ~ ` MAY 2 4 h'~9~ 765-1802 ~l APPLICATION F012 CERTIFICATI: OF OCCUPANCY "" ` ~~"~~ A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the follocaing: 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 Depe. 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 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 325.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - 3100.00 3. Copy of Certificate of Occupancy - $20.00 k. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Dare ..~/.TO...~'3~. t.~~~ .................. New Construction.. ~...... Old Or Pre-existing Building............~,.`.... Location of Property...n.~-.~.~~......~,«:~.~~~ :..................1K~/.f;',.3/JlCI~~'~.fC...... House No. Street Hamlet Onwer or Owners ~~f Property..:~?~P1~?..~.,~~!!~~~"..lYl~C~i4~[9 County Tax Map No 1000, Section.....(l ®.....B1ock...~...........Lot....." °.~ :............. Subdivision......!/ ..............................Filed M:ip.......,....Lot...................... Permit No..lB.TlG~:~:~..Date Of Permit ................Applicant.~~.1Q.!?'dG`7~f/~`eEl....... Health Dept. Approval ..........................Underwriters Approval .l?r~Pf`................ Planning Board Approval ........................ Request for: Temporary Certificate........... Final Certicate....`~ ..... Fee Submitted: $... ~ .................. ~P~t~ U~~~f'~1~ ~ ...... APPLICANT .......................~.'......~. i i, ., I y~ MAY 2 4 ~~: ~ i THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1_1$5077 BUREAU OF ELECTRICITY 65 JOHN STREET, NEW YORK, NEW YORK 10038 care FEBRUARY 03,1992 Application No. nn file 70574290/90 N 222925 THIS CERTIFIES THAT only [he electrical equipment as described below and introduced by the applicant named on the oboee application number in the premises of DOUGLAS McGAHAN, WICKS ROAp, P O#3, NEW SUFFOLK, N.Y. . tt~~ in Ihefollowing Gwationi Cx Boaernent L4 1st FL ®lnd (1. GAR/OUT Section Block Lat was examined on JANUARY 27,1992 and found to be• in romplianre• with the requirements q(this Board. FIXTURE FIXTURES _ RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS_ RECEPTACLES SWITCHES O TLE U TS INCANDESCENT FLUORESCENT OTHER AMT K W AMT. K W. AMT KW. pMi K W AMT. H P. 36 49 37 2B 1 1. 1.2 4 F DRYERS FURNACE MOTORS FUTURE APPl1ANCE fEEDEgS SPECIAL REC'PT TIME CLOCKS EELL UNtT HEATERS MULTI-OUTLET DIMMERS PMT. K. W. Oll M. P. GAS H. P. AMI NO. A W. G AMT AMp AMT AMPS TRANS. AMT H P SYSTEMS NO. OF FEET PM1 WRTS 1 F 1 30 4 ~ ~~~ ~ 2 600 SERVICE DISCONNECT AMI AMP. TYPE __ NO.OF METER EQUIP S E R V 1 C E .. NO. Of CC COND A W. G, q,W G p W G I q 1W 1 9 JW 3.e JW 3,a' AW NO Of H4lFG NO Of NEUTRALS FER % Of CC CONp, OF H4tEG _ Of NEUTRAL ~ - -~ - 1 150 CB 1 X ~ 1_ 1 ~ -_~-_ -_ OTHER APPARATUS: MOTORStl-0.50 H.P. G.F.C.II-5 SMOKE DETECTORt-3 L~~~j, ,-c~'~ ~'(/`-` ~j ROSLAK ELECTRIC LIC.#3677E G P.O.BOX 164 CUTCHOGUE, NY, 11935 GENERAL MANAGER 11 ~'~~ Per _ This certificate must nat be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. S~FFOLh~~ ' ' Ol~~ ~~ ~f ~ ~ ~~ T0~ N OI 50tJT~0~,ID OFFICE OF BUILDI2dG INSPECTOR ~ ~ rn E .:. u' ~"' ,3 !~' ..~. P.O. BOX 1179 TOWN HALL •'0~~~'' ~ ~b~Y 1 r~s SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N TEL. 7G5-i H02 Date ~`2,j ~45° Building Permit No. Owner 17fJUG4AS 1b/IvtP NLC G'A•HMv (please print) Plumber pC`9VEtft~ M.~6A-t}fl-{~, (please print) '° ~ _ ' r( li';' (, i; f;f~ ~~IAY ~ q tgo~, I certify that the solder used in the water supply system contains less than 2/10 of to lead, „ • u tier's signature) Swo' Ira to before me this ' / ~/~~ 02 ~ day of _ ~~ ~/l/v~"'l/~--~.• 199b'^. o ary Public 27otary Public, County ' JOYCE M. WILKINS Notary Pub4ic, State of NowYork Nc. 4952245, Suffolk Coun Term Expires June 12,1 ''" Town I-fall, 53095 Main Road P. O. Box 1179 Soulliold, New Yoik 77971 - ~ >>; ~. . ' ~ ~' r., ., ' S - Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD I F I C A T I O N DATE : / ~D ~~ Building Permit No. ~j~~_r' ~~ Owner : ~AV i~ ~V ~ e'"J% i a cs. ~ %~i ~~~~+>y>d,>;-Fj~ 9.c> , J~l~l z. ~- o,, ~I v vt (please print) Plumber: ~/~P vv~ mod. . ~Jr ~i.~"iri (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. i - Cure) Sworn to before me this ~~ day of 19 ~~ (( N~oyrC,~ar~y_ Public, ~~Q/f,~,~ County C~/~ 0" ~~~' ` `" `~ JOYCE M.WILKINS Notary Public, State of Now York No. x952246, Suffolk Coun Term Expires Juno 72, 19.~ /~~~ v ,.~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [~RAMING [ ]FINAL REMARKS: ~~-~~.~ __ ~~~ DATE~~_INSPECTOR °~~ti~~~~ 7 f L 765-1802 BUILDING DEPT. INSPECTION [ ] FO.~INDATION 1ST [ } 1R000H PLBG. [ /FOUNDATION 2ND [ ]INSULATION DATE ~~ ~ 1 [ ]FRAMING [ ]FINAL I P 7~z t~.~$®Z BUILDING DEPT. ~;~-~•~ [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [)INSULATION [ ]FRAMING [ ]FINAL n n DATE O O~ REMARKS: -- ~~~-~~ U`'~ •cu^ " ~~UAiE 'r'IELD Ib~.~~~IU,J 1. 4 ~ FOUNDATION ~ (1st) __ FOUNDATION (2nd) J 2. P,OUGH FRAME & PLUMBING 3. IIISULATIOIi PER N. Y. STATE ENERGY CODE 4. FI;dAL //Lri[ ~~ ` I ~~..=-llla !2 `~d'" < ~n/~ A~~ ~ 3 ~~i~e z 92 a./ r _ ._ A 7 _.;..- COaKMENT~ ~.. ~.,.. 2~ Y NTS: ro\ ~ U H~~ H ~` O \ 2 [*1 9 r ~A x O d 1 -~v y N Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 ~~O~OSUFFO(,~-Cp~ y ~ y • ~~ 1 ~ ~~o Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD Mr. David Mc Gahan P.O. BOX 602 Main Street Cutchogue, NY 11935 **** SECOND NOTICE **** To Whom This May Concern: March 27, 1995 We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is c__/ not on file. (Enclosed)** xx No Underwriters Certificate on file. j xx The check is not on file. $25.00 ~- xx No Health Department Approval on file. No final inspection has been made. ~~ xx No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984}. BUILDING PERMIT # 18712-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. ** - ACCORDING TO THE CODE OF THE TOWN OF SOUTHOLD, IT IS UNLAWFUL TO OCCUPY OR USE SAID STRUCTURE UNTIL A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED. THIS BUILDING PERMIT HAS EXPIRED AS OF 6/28/91. INSPECTORS Victor Lessard Principal Building Inspector . Curtis Horton Senior Building Inspector 'T'homas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802. :~ l ~~©SU~FO(,~~~G~ ~ ~ ~ _`~ X~ .: _ a `'`~ 1 - ~ ~' o,~"..~0 -- , ~~~1 w:~ ~~ ~ OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD ~' DAVID W. McGAHAN P. O. BO% 602 CDTCHOGIIH, NY 11935 To Whom This May Concern: JANUARY 28, 1993 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 We are unable to complete your Certificate of Occupancy because of the following reasons: ffi An application for Certificate of Occupancy is not on file. (Enclosed) %%X No Underwriters Certificate on file. %%x The check is /not on file.)$25.00 XxX No Health Department Approval on file. No final inspection has been made. RR7[ No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 1871 -7. Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspectar Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 ,4~'~FOI. ~~ 6( ~~ G~ fj: ~ ~~ -~ ~ P. . ~ , , c~ (";~, °'.c N [ v.'t ~t~ ~ `~ 2 ~ ~~al F~ ~~ OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax(516j 765.1823 Telephone (516) 765-1800 February 14, 1992 David W. & Douglas W. McGahan P.O. Box 602- Main Street Cutchogue, New York 11935 Re: Building Permit # 18712-Z Premises: 235 Wicks Road, New Suffolk, N.Y. Suff. Co. Tax Map #1000-110-8-22 Gentlemen: During a review of our files it was noted that the above building permit has expired, and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold, Article XXVIII 100-281 and 100-284 a building permit is needed for any construction of additions, accessory structures or new dwellings, and it is unlawful to occupy or use said structure until a Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOL~D TOWN BUILD~IN~G ADEPT. Vincent R. Wieczorek, Ordinance Inspector VRW:gar (CERT. MAIL) 3j3~4 Z - ~ c~~.~. U(2(..e~ . - ~-~- c~-t-~~ ~e: ~-e.~.~ Ux~yLez~!.u,~, ~., ex_ u~~~J- t~ ceri~-~G ~ Y INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 h~o~~gUFFO(,~-co G o y` y = ~ • `~ ~°y~,,l ~ ~~o~ OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 February 14, 1992 David W. & Douglas W. McGahan P.O. Box 602- Main Street Cutchogue, New York 11935 Re: Building Permit # 18712-Z Premises: 235 Wicks Road, New Suffolk, N.Y. Suff. Co. Tax Map #1000-110-8-22 Gentlemen: During a review of our files it was noted that the above building permit has expired, and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold, Article XXVIII 100-281 and 100-284 a building permit is needed for any construction of additions, accessory structures or new dwellings, and it is unlawful to occupy or use said structure until a Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, StOUTHOLD TOWnnNrnB~UILDING DEPT. V LC~ [`L-W Vincent R. Wieczorek, Ordinance Inspector VRW:gar (CERT. MAIL) FORM N0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTIiOLD, N.Y. 11971 TEL: 705-1802 ~~yy .0....... Examined .~+~~i , 19 ~ // Approved ...~,~/a-: ~ .... / , 1~~Pcrmit No.,l..~ ~i.~~ Disapproved a/c ........... .. . ....................... BOAaD OF HEALTH ............ 3 SETS OF PL.1NS . ~. . SURVEY ...........~.. ... CNECh ...............!~ .... sErTlc mart ................ NOTIFY a ~Ll„ ~ ~1~-7~ CALL .. ~.........../- - - MAI T0: .. ~`~ ~ ?3 ~X !a o 2 ..... . ... c'~!~Gr J`: fur': L Mi...l ~R.3.~ (Bui!~ ing Ins or) APPLICATION FOR BUILDING PERMIT Date .. ~.~ :. Z ~ ....., 15 g.~. INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~ stts 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 pan of this appli- cation. e. 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 thrartghout 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, o or remov or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bu' din c de, o sink code, and regulations, and to admit authorized inspectors on premises and in building for necessary i s ectio v (Signature app leant, or name, if a corporarion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~7 W N ................................................................................................ Name of owner ofpremises - . , J ~`~ S ~3ow ~~rv (as on the tax roll or latest deed) - !fapplicant is a corporation, signature of duly authorized officer. .............................................. (Name and title of corporate officer) Builder'sLiccnseNo . .......................... Plurnber's License No. .......' ................ . Electrician's License No . ..................... . Outer Trade's License No . .......... . ......... . 1. Location of land on which proposed work tvill be done; - .. .. ........... ~:~~ .. .... ~ t~ :~.~:.. ~~ ........ ~~, Sv~~O~-1F- Efouse Number Street. Hamlet County Tax flap No. 1000 Section ...... ~. ~°• • • • ...: Black , . g, , , , , , , , , , , , , , Lot ... a; 02, „ _ .... '', , Subdivision ............... .............. Filed (,tap No. ... ' ((Jame) ........... Lot ............... ~. State c~isting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...........N.~:~!".~ ... L~r!7?..... .. ........... . b. Intended use and occupancy ..................................... .......................... 3. Nature of work (check which nppligable): New building ~.. , .... Addition .......... Alteration .......... . Repair ....... Rpmoval~ .. , .. , .... Demolition ..............Swimming pool ........... . Tennis Court ......... Acdessory Building..........Fence ......,Other Work............ 4. Estimated Cost .......~.6~,~~ ! ....................... Fee ................................ .... j (to be paid on Cling this application) 5. If dwelling, number of dwelling units ............... Number oC dwelling units on each Cloor ................ Ifaarace,numbcrofcars ...... ................................... ......... ............, pcupancy, specify nature and extent of each type of use ..................... . 6. if business, cammercral or mixed o 7. Dimensions of existing structures, if any: Front . .......... ,Rear ..,.. , ......... Depth .............. . . Height ............... Number of Stories ................................... , ................... . . Dimensions of same structure withjaltcrations or additions: Front ................. Rear ................. . . Depth ........ . .............IFieight ....... .........Number pof Stories ......... ...... 8. Dimensions of entire new constnuction: Front , ....~,~.. „ . Rear ..... CPU....... Depth .. ,.~..~.. , , , .... . Hci;ht ....... . ...... Number of Stories .....~ ....... ...................... .............. . 9. 'Size of lot: Front /¢e' , , 'Rear ....'...~.4?? .......:. , . Depth .. , ~.~ . , , , . , 10. Date of Purchase .....47~.. 6.~l~g~Q.•, , , , ....:Name of Former Owner , s.7:~1%^:'-~~• • g~•"'~~........ . , 11. gone or use district in which rem~l , , • / ' , .. • . • ... p Vises are situated ...........................~.: ...................... . . t2. Ddes proposed construction violatg any zoning law, ordinance or regulation: ..... P?!~ ..................... .. l~ /~l 13. \Vill lot be regraded ..c , .... .Will excess fill be removed from premises: Yes .... No . . 14. Name of Owner of premises .. ~, M , ~~ ~" ...Address . fdo Z ..Phone No...'7~..6,~: ; (~-.3:~. . Name of Architect ... '/'ate}dress ... ,~".fe'~~:~'... Phone No ................ . Name of Contractor . .~~.. ~'/~G~-:. f7.:'J,G.dress .. . ,.SR:... ..Phone No.... ... . iS.Is'this property located within 100 feet of a tidal wetland? *Y);5....~.• *If qes, Southold Town Trustees Permit may be required. ~ FLOT DIAGRAM Locate clearly and distinctly all liuildings, whether existing or proposed, and, indicate all set-back dimensions from' property lines. Give street and block number ordescription according to deed, and show street names and indicate whether interior or corner lot. !, ~, 20 t ~~ ~ ~~~~ ~ ~ ',~s ~S~ ,~ .-, ~, i _ -- ~'~2~~ ~ yP ~ J.7 7 Lo~• r:kzv ~ lr-~ \ C ~~ S fza /fi~ STATE OF NEW YO,,(tKj~~ ~~ 'IS.S COUNTYOF.... r........ ..........~~?~<t-! :~....k-:..~. Y!`~:~5'4(~........... being duly sworn, deposes and says that he is the applicant • (Name of individual sigr%ing contract) ,,, about named. He is tltc ........... ,G, ~.N.~~'~"1?'?.....!~? :'~?... ~. ~'~~ ... .... .....:... . ................ . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dujy authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application arc fnic fo [hc best of his knowledge and belief; and that the work will be performed in the manner set forth in the application Glcd thcrewitlt. Swom to bcior`c~me this Q ~ ...........:! . ~~.~ .day o~ ' , ,iIrc'~, ,l'a:Q~ ]9 Notary Public, ~ -~J~S :4~.Q ... .... ........ County 4 ~ 0 n n ,-- Notary PutiBts, State o~ Flew York • • •~`~ ~i~-~ ~` n.,_,u, ~O' ~7a.E~,._.._... w~ I (Si;namrc of applicant) ~: a^..; - f; ~ F' ~ i J!" R , ~ .,:~ ... a~ Y'... t . <t ja *~ t~,,~h'~~„~tp^x5 erP~"±{''~a~.r `~sRi'7A"~~~'~.FPrf k~'TR ~~•}{~ f ~ t ~EG c ~k`.~ x a, J 4 .. ~~ . '~ r" ~ ~' µ ar ~/ ur-=--~+ . H.' ~ ~ ~ i <~ . e. . , !.= ~ ~ ~ ~ ~ ~ ~_q O ^~'M1', e;~ ~ 1' ~ .:gip' 't's~, ~- ~, ~ ~ ~ ~~ ~n ~~ ~~~ ~ ~ ~~ ~ ~ ... ~ ~ b ~ ~G VJ,~~~_ ~M.~i..}C i 3 _ i' ~ ~- _ t ~ ~ ~ ~ ,~ ~ ~ .,. ~~ : -~~ r ~ ~ ~.,- r o P ~ 5 1'T ~:~ ~,~ .. ~- !. ,. ~ ~~ ~ .E , ~ ~,, ;~~ ~ _ R L ~ ~~~ 1 ~~ ~ ~4 F •. ~ lN3i~9Y`~1Y~~lO~i~Y~ gA4~~i~. . 1"L' fix] a&~~V4~YZL`3"'`M1~ r ' 5 l J' h ' F {y`~ •J 4 r i "yi' !1~ V' ~ ~r ~ r } ~ 1`Y `A 2 l4 ~x Y'..f !' 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