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HomeMy WebLinkAbout17963-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-14180 Date JULY 5, 1490 THIS CERTIFIES that the building NEW DWELLING Location of Property 4625 (PRIVATE ROAD X11) ALDRICH LANE EXT. LAUREL House No. Street Hamlet County Tax Map No. 1000 Section 112 Block 1 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed an this office dated MARCH 24, 1989 pursuant to which k Building Permit No. 17963-Z dated MARCH 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 ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WARREN M. & SUSAN C. CANNON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-175-MARCH 20, 1990 UNDERWRITERS CERTIFICATE NO, PENDING - JUNE 11, 1990 PLUMBERS CERTIFICATION DATED JUNE 15, 1990-MATTITUCK PLUMBING & HEATING Building Inspector Rev. 1/81 FOB3S N0. f 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) Na 91963 Z Date 19..1 Permission ~s hereby granted to: .2(.... ~.?~'....5 ro ..4~^:lsd......4.c.....R~1-sr~.. .....l..~t..~!"~:~'!:`.~....~..A,ra..~:~4t~..~ at premises located at ..~R.r~.,~..1.la~d' li,... ..~~.....~~4'~.:.... . c...~.ri.~4AAl.1~ta~F:...~E:~-r.4n ~¢:w-!?,.!1-+1 . County Tax Map No 1000 Section ~f Z....... Block ~1.~.......... Lot No....<?t nn . pursuant to application doted Gl.~t,17. . 199.., and approved by the Building Inspector. Fee s..l..~'~..~!4:..9. S Building Inspector Rev 6/30/80 !'OSM N0. f TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Na 017964 Z Date p t9.$.1 Permission is hereby granted to. ..x.. ~~as n r~:!?~,....N...:~.:....1 ! 9 3 n to ..1.x,4-!v4:~F~QA-`.!1 ...~-~c~a!~.4-k~:.e! n. nw r~..c.5^Qs.:...4~.4.Q,....... ct premises located at ..T.V~.?5....~.Y lF. ~ 1!.~.. cL1~....~.~........'.A./~2~~lA~:k(ti!-~,.. ./..Cr I.yell:Gt.~JQ:Y1.l..'.aCY..l...~!!'!'~'~"~' . County Tox Map No 1000 Section 1.... Block Q.~........... Lot No ..Q? T pursuant to application dated .Z7:•. 19.9., and approved by the Building -Innspector. 111 fee `Y . iC e~ UL Buil ng Inspector Rev 6/30/80 Form No. 6 i OlOH1f1OS j0 NMOl 1 ~9 Cp,~ ,Z, C~l~(1~ '1430 'J0'19 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 , ATION FOR CERTIFICATE OF 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 Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains > less than 2J1O of 1X 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 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. Z. 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, Coem~~mercial $15.00 Date V~~~..`~f~.7~Q New Construction., x Old Or Pre-existing Building.........~.,.~..'.p~... Location of Property..~1C-s..ill.~.~~r1-~.~..~C~RdC~.~s~~14GStlY~4A:~j.'YJ~~4T~~sl~... House N~o~./ Street Hamlet e~~or Owners of Property..V`J.p1t~s~.G.~.1:`if~'~..~.~~..~C'.:.~~~~~~ County Tax Map No 1000, Section.,~.~ ~r.......B10Ck.. ®.~..........LOt. ~t.4............ Subdivision ............................~.,.{......Filed Map............Lot...A...^..-.............. Permit No. ~.l.:t~~.L-...Date Of Phhermiti".IA{~.<~.~~9~~.Applicant~~.1J.1-~}.L`t`L,l~L5~~.gq1.~3.~. Realth Dept. Approval...~~~~.4-~.1g~~~~...Underwriters Approval.~~N'ti.71;.Ly~..l~.. _ , Planning Board Approval tLARdJD~~~~~ Request for: Temporary Certificate........... Final Certicate.~........R •GD('IA41 Fee Submitted: ;...:2~s PO ~ 19J8~ APPLICANT ,c~AM~S RE.CJE`FR+ e z _ a g ~ ~ w ; U) O N ~ _ ;Z \ d m < ~ w ` m W D ~ d C o K ~ ~ ~ !Z~ cq 'C.. V w - ~ 2 ~ ~ y W V1w ~ ` ~ ~ L ~ j T. y 7f~ Z ~ N x ,Y ~ t ~,np o N 7 v z _ e _ W ~ ° ~ ~ f N w$ ~ D ~ ,.y ~ a 5 W $ ~ .4. F ~W y K e i ` ' W 3 a L z" ~ - ~ o .Q ~ ~ > z ~ £ W y ~ O 5 x N m W ~ ~ ro ~ ~ $ N W o ~ - J z ~-i ~ O ~ 'g a u~ N ~F ~ a Z Z ~ m v~ 7 ,e W Y I~ U H Y ~ C +y1 4' Y ~ y N i M u ~ K v1 C 3+ b Z - y0 a W Y O ~ m e p" ~ y - ~ u F ¢ 7 8 ~ ~ uo ~ Q uW a ~g J o 0. 0 ~ s ~ LL. W W i1'. q C ur r ~ tR ~ ~ W O W Q C ~ iJ dT ] 0<i y r{ 2 iL W ' ~ k ,Q ~ H~ w o p O ~ W C .O x 7 ~ N u 6 Q 7 Z ~ O =v ~ rc N o' o V Q \ 4 0 d' W ~ S Q ~ o r ~ a rf N i H ~ W 4 ~ ~ y ~ g m m0: q z o N ° y. a! = R p G7 ~ ~ M ~ Z 3 y~l ~ ~ O u n @ O m M Q S~ .i ; N 5 v G^ m K c Q m ~ [ N 4 9 Q +1 u «-7 r~-1 E W ~ ~ ~ ~ Cn > n Rf C h C yy ~ O W ~ q u 3+ O O 6 ~ ~ O d r~i z ~ ~ S 9 Sa H ~ ~ Z Oti G m ~ 0 to 4e O q 'z v ~ y Yu' ~ O w _J rt 'i A q G x ~ y O W a; H d O ® ro ~ rn ~ gfS ~ aNS ~ .'d- c m y < E ~ c ~ N ~ arc. n aa~ o ~ c°C3 ~u. H R H ~ ti N n~ ~ w ? N i0+ O~ ri H~ a LL. Ft ~ V y \ y,1 ~ ~ UI ~ s ~ y a w Z r-1 CS J q I~ O ~ d P. _W a a C < ~ .p Z ~ r'i ~C ^A W N cA ~ O LL ~ C ~ ~ ~ ~ ~ O ~ q 1-t fi It i (V ld W 0 , C W 3 ~W~ ~ ~ a O q~ U O ..-t a V d 0 t N N x V b P1 aJ O W O~ C ~ e ~F w ~ ~ .1N~a0 S3 N ~ ggig ~ °J ~ ~ ~ ~ ~ D ~ p y ~ O~ O ~ ~ ~ 3 r-i i t+1 N r~i ri O~ r 3 O t' 8.I1f(P(IfSIR{~f(~M:t7ttMf+~ N~{S@[M!ltIWSIMIMIIM'IlIW ! ~ 1p11~' HAROLD R. REEVE & SONGr INC. a ; BUILDING CONSTRUCTION ~ ~1 ~~5i" COUNTY ROAD 4B P O BOX 7441 ~ ` ( 7 ' 3 MATTITIJCK, L I , N Y Ilssz spy ~ ~ ~ f TELEPHONE 516 y98-4]13 f 1 ~+~w... a..a...,.,~ f3lUG L,. f'( TR4NN OF SOUTHOLU May 30, 1989 Building Dept. Town of Southold Town Hall - ATYS Route 25 Southold, DTY 11971 Re: Permit No. 17963 Z Cannon Residence Gentlemen: Please be advised that we are the builder on the above project. The permit was issued on P4arch 28, 1989 to the architect, Donald A. Denis. The electrician will be Paul Burns of Southold and the plumber will be Mattituck Plumbing & Heating Corp. Any questions concerning the construction of the Cannon Residence should be directed to our office. Yours truly, HAROLD R. REEV(En/ & SORTS, INC. r a es eeve JFR/ea S~+J Z~0 Z~j i 0 5~~~ ~ / L~ ~6~~~`~ ~ ~ ~ ,~`i ~ ~ ° of \ ` m ~ ~a d" ` .~f d , N 2 e 0, N ~ //C7 g ~ / > `bo f \ 4 /o/ ~ ry s~f 'f ~j, ~ ? u. ~ P O, / ~ '~G O V ~ O \ ' I s ~ ~ ~ e 4° d' tc` b 8qs H Y~y i j~ 4 l" iN • rte[ ~ C ~ ~ C SO. i ~ O t O { 0 9 ``i ~ 0 0 C' ~G~a~c G TEL. 7G5-1802 ~oc~~EF~L,S-~, TOWN OF SQTJ'TE03.ID O O'IOHif10S d0 NMOI , rc OFFICE OF BUILDR~IG INSPEC'T'OR ld3a ~~a7e ~ P O BOX 728 r ~E TOWN HALL ~ ~ $ 1 D~aol SOUTHOLD, N.Y. 11971 ; i C E R T I F I C A T I O N Date t~ \r~5, IgG o Huildug Permit No. l`i9~a3 Z owner~iq,`~(2~A( ~'~^.?~Ai~! Cka1VNC1}V (please prninty Plu^Wer lYl/~1~~TL~c..1C R~ ~s~.16,~~1~ , (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1g lead. f (plumber's s' e! Sworn to befor^_ me this ,~/~s ~nc/' day of ol7.lN~- ~ C~ ~ +,~-~9yc~ , 19l!• Not Publyc tlatary Public,~'~,!GFrJL.~' County ~ l~1H* NCIMI~NI.~_Np~~ T Qpbi~ h0. tfi, lp~ IcLD I;. S:EC::U;J ~~U~ic ~OPtME;NT° ~ y r ^O H H ?OUNDATI0:1 ( 1 t c =OUNDATIOiJ (pad) m 2. z o ~ .ROUGH FRAME L < < PLUMBING ^ m 3. a m ay IIdSULATI0P1 PER N. Y. 'j STATE ENERGY CODE x ~ a . - - F I iJ A L C~vt r,.a,o i ii ~ I~ a ADDITIOPIAL COMMEPJTS • ~ x c • 8zi .ce, 1/ Y R ~ O ~ m ' x ^a _ H • 9 H H Q ~ [ r _ H i T d m -v - 'j G HAROLD R. REEVE & SONS, INC. BUILDING CONSTRUCTION COUNTY ROAD 48 P O 60% 1447 MATTITUCK, L.i , N Y n9sz TELEPHONE 576 298-4713 June 13, 1990 Building Department Town of Southold Southold, NY Re: Cannon ResLdence Aldrich Lane Extension West Mattituck Gentlemen: We wish to apply for a final inspection and Certificate of Occupancy for Building Permit No. 179632. Attached for your use are a copy of the Final Survey with Health Department Approval (8850 175 dated March 20, 1990) and a temporary Underwriters certificate dated June 11, 1990. At this time we are not also applying for a C. 0. for the pool, pool house and garage unde~ermit No. 186682. Yours truly, HAROLD R. REEVE & SONS, INC. tJ.-1... ~"Q~C~-~.-° ames eeve JFR/ea Encs. HAROLD R. REEVE & SONS, INC. BUILDING CONSTRUCTION COUNTY ROAD 48 P O BOJC 164] MATTITUCK, L I , N Y 11952 TELEPHONE 516 298-d773 June 9, 1989 p L~~[~~1][~ Building Department Town of Southold 12 I9i89 Town Fiall - NYS Route 25 Southold, PIY 11971 BLDG OEPT TOWN OF SOUTHOLO P.e: Permit S;o. Cannon Residence Gentlemen: Attached is one cogy of a survey by Young & Young dated June 2, 1989, locating the new foundation on the lot. LJe trust that this location meets with your aggroval. Yours truly, HAROLD R. REEVE & SONS, INC. l,___._ awes F.. ReY eVe - JFR/ea Enc. t a, , a New York State Department of Environmental Conservation Buildtny.410-'~SnyONY~'Stporgt Brook,?tew'11'ork'fi79~ y J ~7 ~/j~ ~O~rO~.,l: " ' `t'~-Y\~S DATE: /'~r~J J,~O c~ A. y i p y}^- Thomas C. Jorl[ny v~"~" J~~~ 1 ` k~~ Commissioner Dear A review has been made of your proposal to: Cc~ns~(~j S \ Y`(~ ~~v\.~ 1 y ~.v~,~l ~ v~ gay c~ ~e.5 c~ Y i ~2. C`S ~ a~.ti~.~ d~~~ ~ol~-~t~~ tc~c~.~c~ o~\ rt v~~ b~- v~ S©v ~ ~4-~ eve t~na_~~~-" ~k 5 Bas dvoh t~e~~formation you have submitted, the New Xork State Department f Environmental Conservation has determined that the parcel project is: Greater than 300° from inventoried tidal wetlands. Landward of a substantial man-made structure greater than 100' in length which was constructe prior to 9 20 77. _ Landward of the 10' above mean sea level elevation contour on a gradual, natural slope. ~xLandward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. Therefore, no permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conservation Law). Please be advised, however, that no construction, sedimentation or disturbance of any kind may take place seaward of the 10' contour or topographic crest without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation in this area as a result of your project. Such precautions may include providing adequate work area between the 10' contour or topographic crest and the project (i.e. a 35' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. Please note that any additional work, or modification to L•he project as described, may require authorization by this Department. Please contact this office if such are contemplated. Please be Further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. C~ h~. ~ Deputy Regional t~e mit Administrator e~ (5181722 3511 TELEPHONE DONALD A DENTS A I A, P C ARCHITECT AOUEBOGUE SQUARE RTE 25 P O BOX 365 AOUEBOGUE NY 11931 DONALD A DENTS, A I.A FREDERICK R WEBER. R A March 22, 1989 Mr. Victor Lessard Southold Town Building Dept. 53095 Main Road P.O. Box 1179 Southold, New York 11971 Re: Proposed Residence CANNON, Warren & Susan Dear Mr. Lessard: q Enclosed please find one set of Construction Drawings, Building Permit Application, Survey with Health Department approval thereon, Letter of Non-Jurisdiction from the D.E.C., blank check made payable to the Southold Town Building Department and Application for Construction of Cesspool with check for $10 covering fee for same. We hand-delivered three complete sets of Drawings to your office on Friday. In today's mail we received some of the items back, including one set of plans. Therefore, you still have two sets of drawings in your office. Please review the paperwork for the required permit(s). Also, we ask that you advise us of the amount of the building permit fee when it has been determined. Ve truly yours, DONALD A. DENIS, .I.A. DAD/lv Encls. 17 ~ ~3 ~~-isoz BUILDING DEPT. INSi~ECT10N [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION ~RAMING [ ]FINAL REMARKS: "J DATE Ib ~ INSPECTOR ~ ~ Tss-isoz BUILDING DEPT. INSPECTION NDATION 1ST ( ] ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ( ]FINAL c v~ REMARKS: - G D,~''rE ~ / INSPECTOR f )7q(~~ 765-1802 BUI4DING DEPT. INSPECTION [ ]FOUNDATION 1ST UGH PLBG. FOUNDATION 2ND ( ] ll~l~ ULATION [ ]FRAMING ( )FINAL REMARKS: Q~(.i~v(r~ ~i~-L~~ DATE IJ d I INSPECTOR ~fil~, ~~0,3 765-1802 + BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST j ]ROUGH PLBG. [ ] FOUNDATION 2ND INSULATION [ ]FRAMING ( [ ]FINAL REMARKS: ~J/~~ ~!i_ v DATE ~ INSPECTOR / G I ~ 765-1802 / / BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: _ ,~~Cu~ ~ r ~ / J r G~ L~ / , °`a DATE ~ INSPECTOR - - - - - R- - m r.J G, K~ ' ~ ~ ~ L5 0 U ~ 'FORM NO t ~ TOWN OF SOUTHOLD ~ ~ K 2 ~ Can BUILDING DEPARTMENT 3~a-to o k TOWN HALL I~-~.ee~ ~F 9 SOUTHOLD, N.Y. 11971 ' ~ TOWN OFSQt~t TEL.: 765-1802 Examined ..,(k~.R.~-zDA. oZg..., 19~g. 1,79 b~,~ Received........... , 19 Approved ~ai.t.~. 14 19~`l. Permit No. Disapproved a/c . (Building Inspector) APPLICATION FOR BUILDING PERMIT March 13 Date 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, w sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing location of lot and of buildings oit premises, relationship to adjoining premises or public st or areas, and giving a detailed descnption of layout of property must be drawn on the diagram which is part of this a 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 pe shall be kept on the premises available for inspection tltrougltout tlic work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occup shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to t}te Building Department for the issuance of a Building Permit pursuant t~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinanc Regulations, for the construction of buildings, additions or alterations, of for removal or demo~tiOn, as herein descri The applicant agrees to comply wdh all applicable laws, ordinances, bu' ding code, housm co I and regulations, an admit authorized inspectors on premtses and in building for necessary msp~ct' s. j v (Signature of applicant, or na e, if a corporation) P.O. Box 565, Aquebogue, New York 11931 . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buil ARCHITECT Name of owner of premises N'~ & SUSAN CANNON . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. N/A . . (Name and title of corporate officer) Builder's License No..~~, . ~~L'~~t..g. ~ ~6 ~1~ Plumber's License No. . ~~'i.-`.-~~. ~ R'i-'~''~' Electrician's License No. .....~G.ri-Q .~.e~,~:w<1 „ Outer Trade's License No . . 1. Location of land on which proposed work will be done. (3905' north of Sound Avenue) LDRicH eh Ext. 4625 Private Road X11 Mattituck House Number Street Hamlet 112 O1 014 County Tax Map No. 1000 Section Block Lot......... Su(tdivision 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 VACANT b. Intended use and occupancy , ,Single Family Residence - ' 3 Nature of work (check which applicablex ~q Building }g{ Addition Alteration . Repair Removal , Demolition ..............Other Work (Description 4. Estimated Cost....$425x000 Fee (to be paid on filing this application) 5. if dwelling, number of dwel]ing units Number of dwelling units on each floor . . . . If garage, number of cars ~ ~N%9~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of existing structures, if any: Front ...............Rear Depth . Height Number of Stories . Dunens~ons of same structure with alterations or additions: Front Rear . Depth ......................Height . ~ Number of Stories . 8. Dimensions of enure new construction: Front ..92..4........ Rear 92.-4........ Depth .52........... . Height ....34'.... .Number of Stories. .?x.52? ~ 9. Size of lot• Front . 200 Rear ......200......... , Depth ..924.............. . 10. Date of Purchase ..1984 Name of Former O ne; Search 11. Zone or use district in which premises are situated , , , ;~A.' Residential-~~ricu~tixral. 12. Does proposed construction violate any zoning law, ordinance or regulation: . l3. Will lot be regraded YES ........Will excess fill be removed from premises: 1 No l4. Name of Ownet of premises `Varren~ Susan CannorAddress . Southoldr NY , phone No. ?65-3716 . , , , Name of Architect . Dons l~l, A, , l~eu~g, . ~r is A, ...Address . Ague?~4~e, .I`l?'. Phone No. 722-35~~ . Name of Contractor ,Harold,R;'.Reepe.&.Sons,„Address .Mattitugk,,IdYS***?phone No. 29$:47X.3....... *Calves Neck Road **P.O. Box 565 PLOT DIAGRAM ***P.O. Box 1441 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 nterior or corner lot. ~TATE OF NEW YORK, S S :OUNTY OF ..$iX~JaK . DONALD A. DINIS , , , , , , , , , , , , being duly sworn, deposes and says that he u the applicant (Name of individual signing contract) , uuve nameu. le is the .................ARCHITECP.. _p (Contractor, agent, corparate officer, etc.) :k said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ppiication; that all statements contained in this applications, ate true to the best of his knowledge and belief; and that the pork will be performed in the manner set forth in the application filed therewith. wom to before me this n 4 ......~~.~...........day of 19~ . : lotary Public, County I o 1N S~ YOLt~F10ELlEH IG~IJu[~L.~ NoNryPul>t{c,Stat,dNwYc~ 1'1 (y u ~,'u ~5 (ignatureofapplicant) . iyo.<9~T02-8ulblk ..w. DONALD A. DINIS Term EXpfrw Aprif 4, t9~ m~ (Archa tect )