HomeMy WebLinkAbout17204-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCIIPANCY
No Z-22977 Date MAY 2, 1994
THIS CERTIFIES that the building RENOVATION
Location of Property 1555 FLEETWOOD ROAD CUTCHOGIIE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 137 Block 4 Lot 34
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JOKE 29, 1988 pursuant to which
Building Permit No. 17204-Z dated JULY 14, 1988
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 RENOVATION TO E%ISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to WILLIAM F. & JANET A. WALSH
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-136996 - JUNE 21, 1990
PLUMBERS CERTIFICATION DATED APRIL 13, 1994-MATTITUCR PLUMBING & HEAT.
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Buil ing Ins ector
Rev. 1/81 r
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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)
0 ~ 17 2 ~ Z Date ......~............1! .1 19~
Permission is hereby granted to:
...^3 ~.?c.. s:
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at premises located at ..~.5.~~..~.......1.'...~4R~R.d:...../~4b.:.........1,.M~./.1A.~2...............
Caunty Tax Map No. 1000 Section .......~.3..7...... Block .........Q.7..... Lot No....w~..:~"
pursuant to application doted ........~.itrf~!'SJ,t.....tr~..9 19.~.~„ and approved by the
Building Inspector.
Fee $....d...~.t.:~:5/
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Bu ding Inspector
Rev. 6/30/80
PU1
04i26~94 14102 I \
~ $ S16 4'.7 :303 maL5H CORP. ~ pS
7 D~~ Form Na, 6 ~
TOWN OF souTNOLb ~f? f
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DUILb1NG DEpARTMRNT ~L~?. ~ ~9
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765-ig02
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PLICA'P1DN FOR C4RTTFICATLT OF OC4UPA11CY
xt:i6 application muse bs fi]led in by typewriter OR ink and submitted to the building
inapcctor with the fullowiua: fur new building or new use:
1. Fiua1 survey of property with accurate location of all' buildings, proParty l;nes+
street®t anti unusual natural or topographi,~ PeaturCa,
2. Fimsl Approval from llcalkh vapt, e£ water supply and sewprnge-disposal(S-9 formj.
3. Approval of electrical installation frottt Dorird of 1°ire Underwriters.
4. Sworn statemenc from plumhnr corxifying Chat ChC solder used in sy6tem contains
isas than 2/10 of 1~ lead,
. 5. Commercial building, lnduatrial building, multiple raaldenGea and ,ialilar buildings
and instna.lntione, a certificate of Codq Gumpiianae Prom architect or ¢nginegr
xesponsihie for. the building.
6. Submit' Ylsnnixxg Boarfi Approval of campletpd pi,t.e plan reyutt'p•nentA.
1°or eRisting buia.dinga (prior to April 9, 1957) non~uon£orming uaaq,, ur buildings and
"pre-exiatin~" lane] u@pg;
1. Acauratc survey of property allowing all property linos, streets, huilding and
uuueual natural or topographic faaiurps.
1, A properly complap~d appllcatjun and a couspnt to lnapect ai<el by Che appl.tcant.
tt a Gartificatu of Uccupnney is denied, the Building Inspector ehyll sate the
reasanr th~sre£ar in writing to the appX~eant,
Fgga
1, Certificate of ggpupanty w Ntxw dwelling $2J.00, Additions to dwell~.ng'~ .OD',` '
Alterations to dwelling *~25.OOy Swimming pool $25,00, Accem:aOty t,uildin$25,00,
Additions to acccsQUry building $25.00. Buainae8es $50.00.
2. Certificate of Occupancy on Pre-exiatinR Buildin¢ - $lOD.00
3, Copy pf CerCifiCnte of gccupancy $2D.D0
4. updated Certificate of Occupancy"- $50.00
5, Temppr•ary Certificate oC Occupancy - Ctesidential $15.00, Con:marcial 515.00
Dots ......`.~4.yye • , .
Aew Cvnettuction..,..,•,.,, Old Or Pre-cx fisting Du17.ding: rl. f Yr,..,,...,,
Locakiotl of Property...~~.~~..~...........~L~~TkO0o1~../1'a.fT~........G.~Tcf/c:;7u~....
llousa too. 5trpoL Hamlrt
)ewer or Uwnern of Propgrty.I,fo~GGlAM ~ WR~yH ~ . ~~4N~T. L?AGS /-J~ _ ~ , . -
;ounty Tax Map Na lUUU, 58ction..,~.~:~.....,D7oCk,,..T.:,...,....LoC..~~.~
&ubdivie,ion.,..• .........................//......Filed Map.,.,.,......Lot......................
Permit No. p E,7 zC?:F.;~...DaCS Of Permit..5t...~,:~:,~S..Applioant.....,......•
Health Dept. Approval..... ......................Underwriters Approval. „
Plane i=,q Hoard Approval
RnquagNt fur; Tetnporary Certifl.eaLe....,,,.... Final Car.ticato...:~-.,..
c.o ~ ~ ~ Q '7.1
W. F, Walsh Structures Corp,
P.O. Box 569 • Floral Park, NY ~ 9002 • TELEPHONE (596) 437-2250
April 14th, 1994
Office of Building Inspector
Town of Southold
Southold Town Hall.
P.O. Box 1179
53095 Main Road
i -Southold, NY 11971
Attn: Mr. Fish
Gentlemen:
Enclosed please find CERTIFICATION signed and
notarized by Mattituck Plumbing & Heating.
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' Very truly yours,
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William F. Walsh
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TOWN. FSOUTHOLp
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II~ISPECTOR5 ~,.-axr~-,;;,
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. ~ is vc ~ ;,y SCC1TT L. HARRIS, Supervisor
° ~ Southold Town Hall
Thomas Fisher w ya, C 4 ~ p,0, goy 1179, 53095 Main Raad
~
Building Inspector :.t'~, 4-'' ~ .
c~`r Southold, New York 11971
Crary Fish ~0( F,vt ~a Fax (516j 765.1823
Building Inspector Telephone (516) 765-1800
Rahert F'iaher
Assistant Fire Inspector OFFICE OF BUII,I7ING INSPECTOR
Telephone (516j 765-1$02 TOWN OF SOUTHOLD `
C E R T I B I C A T 14 N
. ~ DATB: '3 /~1
Building Permit No. ?7Z6¢ Z
Owner- b~l1GlAM y~ JAW~T WAcy,/a ~S ®.,a.,m,_
- (please printer-- 1~ ~ ~ ts'
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klumber: `~~r?I~- ~/c~m~g7nc `l"l~t'G0-• ;~i~ ~R
please printer--~ ~ ~ ppx' t 8 4-
' rpWNtDG. DEPT' °°~..a
OF SDU7tppL~~
I certify that the solder used in the water supply system
contains less than 2/10 of IZ lead.
(Plumbers Si nat
Sworn to before me this
~~~/PL~ day of ~P~/ _L 19~.
Notary Public, ~S'I~G/?J/,~G County
w~~ ~
Notary Publi
EDYTN F. JAC!SSO{a
Ndary Public, &tate c' r!s"~ York
No. aszo~ss
t1ueFHod M Suflolk Courtly
Term Exfrae feb. 78, tab
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:1cLD i2:SPEC:I0;7 ~~llATE ~ i;OaKMLNT° ~ ,
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~OU2JDATION ~ (1st) o
=OUNDATIOIJ (2nd) ~
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STATE ENERGY Q o1 ~ ~
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ADDITIOPIAL COMMENTS: ~ x~
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Town Hall, 53095 Main Road Fax (516) 766-1823
P. O. Box 1179 _ ~ Telephone (516)'765-1802
Southold, New York 11971 iS
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OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 20, 1994
' Mr. William F. Walsh
P.O. Box 509
Floral Park, NY 11002
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To Whom This May Concern;
We are unable to complete your Certificate of Occupancy
because of the following reasons:
7IXx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
Rxx The check is not on file. ($25.00)
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 # BP# 172042
Please contact our office on this matter. Thank you for
your cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ J FOUNDATION 2ND [)INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: T"~~~` ~ ~r l~ ~ ~ '
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DATE I3 ~ INSPECTO _
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BUILDING DEPT.
1 NS~ECTION
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[~'j~FRAMING [ ]FINAL
REMARKS: o~
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DATE ~ ~ INSPECTOR
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765-1802
BUILDING DEPT.
INSPECT!®N
[ ] F UNDATION i5T ~ ) ROUGH PLBG.
[ FOUNDATION 2ND [ )INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~~c~-
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DATE ~ r~ INSPECTOR
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765-1802
BUILDING DEPT.
M NSPECTION
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F NDA~15T [ ] ROUGH P46G.
[ ]FOUNDATION 2ND [ ]INSULATION
[ 7 FRAMING [ ]FINAL
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DATE I ~ INSPECTOR
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BUILDING DEPT.
tNSPECTiON
[ ]FOUNDATION 1ST ( ) ROUGH PLBG.
[ ]FOUNDATION 2ND [L~NSULATION l ~ 2,
[ ] FRAMING BB [ )FINAL
REMARKS:,~~t~ „~.,y f S~
DATE~~INSPECTOR ~ ~s-~,~1`
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BUILDING DEPT.
tNSt~ECTtC~N
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ }INSULATION
~RAMING [ 7 FINAL
REMARKS: ~
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DATE ~~~~INSPECTOR ~
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T6S-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] !ROUGH PLBG.
[ ]FOUNDATION 2ND (]INSULATION
[ ]FRAMING [ )FINAL
REMARKS: _r-
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DATE ~ INSPECTOR
l 7 ~ ~ 765-1802
BUILDING DEPT.
INSPECTItJN
[ ]FOUNDATION i5T ~ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ -INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: °t'
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DATE 0 ~ INSPECTOR
Il7zo~
ts~-iso2
BUILDING DEPT.
INSPECTION
[ ] FOUNDAT{ON 1ST ( ]ROUGH PLBG.
[ J FOUNDAT{ON 2ND [)INSULATION
[~RAMING [ )FINAL
REMARKS: T(i
DATE INSPECTOR
L~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST (~GH PLBG.
[ ]FOUNDATION 2ND [ INSULATION
[ ]FRAMING / [ ]FINAL
REMARKS: V~ - J
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DATE 0 ~ INSPECTOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS KACe '
1CIL?IJ ;114
BUREAU OF ELECTRICITY
BS JOHN STREET, NEW YORK, NEW YORK 10038
JIJ tt F 21,7Y90` 6397/i9R9)89 N 1;iE99o
Date Application No. on file
THIS CERTIFIES THAT
only the electrical equipment as described 6ebw and introduced by the opplicont named on the oboes applicotion number in the premises of
Hllt WAt.SH, PLF.ESW(i0G K13., P(ri.E1Y35, CUTC;NOt,UF:, N. Y. ,
~~-~55 aTTtc Jour
in thefollouing loca4.ii;nhl, Basgrtaent LJ let F(. ~ 2nd FY. .Section B/oek Lot
u~as examined on 7 111. 11 YY YY 7 and found to 6e in comp/ianee with the reyuirententa q(thia Berard.
NXTURE lCEPTAClES SWITCHES FIXTURES RANOES COOKING DECKS OVENS DISH WASFItRS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMt. K.W. AMT. K.W. AMi. K.W. AMi. K.W. AMT. H.P.
(T T) 67 50 k9 1 7.6 ] 7.2 h 1'
DRYERS FURNACE MOTORS EUTUR! Ahl1ANCE IREDERS SF[CIAL RlC'Pi TIMi CIOCKE YLL UNIT HEATERS MUETI-0IITIET DUAMERS
AMT. K. W. Oll M. P. GAS N. P. AMT. NO. A. W. G. AMT. AML. MIT. AMPS. TRANS. AML N. P. SYSTWS AMi. WATTS
NO.OR FNT
,1 r 1 ao f
SERVICE DISCONNECT NO.OF 5 E R V 1 C E
AMi. AMP. TYPE ~ F. 1 / LW 1 A 3W ] B' ]W 3,P' ~W NO. O~RC~COND. OF CC. COND. ~ NI~IEG ~'HI'IEG NO. Of N[UTRAlS OF HEU pAt
I 2D0 CB 1 X 1 5l0 1 Ala
OTHER APPARATUS:
noroK~~~1-, s(3 w. w_
F"ANELt1UAKDS:1.1-% (:Ik. lflf7
G.P'. c. T:-317
SM?1KE t?ETECTOR:-1
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B. J.p:LEC.iC3q.~ LTC.#?&7[)-E
$OX ]6, ST ILLIJ~TEK AVE.
C.UTCHgtd?JF,~ NY', 13.x:,14 ONENAIMANAONI ,
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This certificate must Floc be altered in any manner; return to the office of the Board if incorretl. Inspectorsmay be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS C TE MUST BE ALTERED NtANY MANNER.
b ~l BOARD OF HEALTH
FORM N0.1 3 SETS 0~ PLANS .
SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHO LD, N. Y. 11D71 NOTIFY 9-(0
TEL.: 7651802 CALL . !~a?.~.'a7:ZS`2~....'M'r'
Examined . ~ ~ i. 19~.g MAIL T0: .
Approved (!.X.., 19 Pcnnit No..~..~o~,.~? ~ ~ ~
Disapproved a/c "
.~5.~! 19;.y a-t..0~...... '1'UWBPILU~ SOI?TfiOLD
(Building Inspector)
APPLICATION FOR BUILDING PERMIT ~ ~3~
Date 15Q..
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.
~ ~ i;e 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. 4
..lq~~'~nc?~ . .
(Signature of applicant, or name, tf a corporatton)
' (Mailing address of applicant) ,
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
t OP~i~~X
Name of owner of premises ~~GZd~i~ ~ ~ ~ (,~//y~~~/
.
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer,
(Name and title of corporate officer)
' Builder's License No.
Plumber's License No . .
Electrician's License No . .
Other Ttade's License No . .
1. Location of land on which proposed work will be done. L~,~!~~°'0 /t f>f/.~
Js.ss......
House Number Strcet~ Hamlet
~ 1
County Tax ibtap No. 1000 Section Blpck , , , , , , , , , , , Lot
Subdivision Filed Atap No. Lot .
(Name) y'
State existing use and occu Inc of remises and intended use and Deco
a p' y P panty of proposed construction:
a. Existing use and occupancy ......1~~.5. 1 DL"-N~.~ ..................yty}~,...; ~t~lA~
. Intended use and occu ant ......~~1Mf • • • .L.~.~. ~GNt : _ . " . • , .
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, . Addition ~ • • • • • Alteration . ~ .
3. Nacpure'ofwork checkwhiRhm plicable): New Eluilding
( P
R.e air Pval . . . Demolition Other 1Vork .
(Description)
4. Estimated Cost ...:2.~ Be4 : Fee .
(to be paid on Filing this application)
5. If dwelling, number of dwelling,units • / Number of dwelling units on each Cloor .
If garage. number of cars . . . . . . .
6. if business, commercial or mixed occupancy, specify nature and extent of each type of use . .
7. Dimensions of existing struc[urds, if any: Front . . .Rear , Depth .
Height .............'.:Nutt}berofStotics..,.......,......,...,,..,..•..,........................
Dimensions of same structure with alterations or additions: Front . Rear , .
Dc th.
p •~3,Q ~ , , • . , . , •I.. Ilcight , . , . Number of Stories .
• Dimensions of entire new construction: Front . Rear , Depth .
Height NutrjberofStories.
Size of'lot: Front ~ Rear . , rfd.... • , , Depth ?,+~`•r , .
10, Date of Purchase ~~8.~' . • . . . . Name o Fotmer Owner , ,L. • .
Zone or use district in which promises are situated . , , ,~1.".. ~~d. • • • • .
12. Does proposed construction violate any zoning law, ordinance or regulation: , • • • • . • , .
tVill lot be regraded Nill excess fill be removed from~~e~tises: Yes e No
4. Name of Owner of premises WLG w~'L's~, ...Address !°a :8d:f. ft9 ~'~L tone No..~/.~~ 7.2 z ~
Name of Architect .~".N'9'°~ ~~•"l• , . • Address 378,ac6~N.r~~,gn;~~?~hone No .
.
Name of Contractor . Address . .Phone No.. .
15.Is this property located within X00 feet o£ a tidal wetland? *YL+S....NO....
*If yes, Southold Town; 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 tines. Give street and block>zumber or description according to deed, and show street names and indicate whether
interior or corner lot.
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STATE OF NEN Y R ' S,S
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COUNTY
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. . . • • . • • • • ^ • : • • • • • • • • • • • • • • • • • • • being duty sworn, deposes and says that he is the applicant
(Na ~ of div~dual si~mi~g contract)
about named, ~ ,
Hcisthe.,...., ...,...,.I
i (Contractor,agcnt,corporatc officcr,ctc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; [hat all statements contained in this application arc true to the best of his knowledge and belief; and that the
work will be performed in the mannerse[ forth in tl a application Glcd therewith.
Sworn to before me this/~
I..
~`v, :day of ' 19 .
\otary k'ubJic, .`~~.,J'~~.c•'.v.".~: • County
CWIRR 4• glEYl? .
Negry PuMb, State, of New Ywk . .
No.A878¢08 (Signature of applicant)
QualHled In 9u Ik Caw+ty
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