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HomeMy WebLinkAbout51545-Z TOWN OF SOUTHOLD ` BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51545 Date: 01/14/2025 Permission is hereby granted to: Peter Kontopirakis 1560 Willow Dr East Marion, NY 11939 To: install exterior basement door and stairway to existing single-family dwelling as applied for. Premises Located at: 1560 Willow Dr, East Marion, NY 11939 SCTM#22.-5-19 Pursuant to application dated 11/12/2024 and approved by the Building Inspector. To expire on 01/14/2027. Contractors: Required Inspections: Fees: Single Family Dwelling- Alteration $250.00 CO-RESIDENTIAL $100.00 Total $350.00 li "__ Building Inspector TOWN OF SOUTHOLD=BUILDING DEPARTMENT l Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 htt s:flww ,southoldto rn�� 0 Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only M NOV �. � PERMIT NO, �, Building Inspector; � � �� � � Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: 0 Z Z OWNERS)OF PROPERTY: Name: - 1 'S SCfMOD- .. Project Address: 1 S O Q Ac' ors 3 Phone#: Email: Mailing Address: X Z Z '2, 0 , i4 Z CONTACT PERSON: Name: ?'e-T e A J 1 C"a Mailing Address: �U Z d Phone#: 917 l I q Email: G 6 + wtq DESIGN PROFESSIONAL INFORMATION: Name: A Mailing Address: o V-�� J 71 fl b� Phone#: (D� 3 3 90 Email 5 5 �J L1 t CONTRACTOR INFORMATION: Name: � C-4 O nr- \JJ1 f c J Mailing Address: ( 1 Hdfs iV Phone#: 16 Email: I'1 e- DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair El Demolition Estimated Cost of Project: o XOther a S'erM e A4 �_ o o q� c-C w 5 $ Will the lot be re-graded? ❑Yes' No Will excess fill be removed from premises s 1 q i PROPERTY INFORMATION Existing use of property: Re e n-A-\ JX t dM Intended use of property: �-{Si den4-t M AUM Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to C) this property? ❑Yes Goo IF YES, PROVIDE A COPY. ❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. 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,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(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. s Application Submitted By(print name): ���- KvN7oe/2A-�I ❑Authorized Agentr� Owner Signature of Applicant: _ Date: ) ] Z 1 Z I STATE OF NEW YORK) SS: COUNTYOF SUF90k-4C ) FOTEZ IC coN'T t being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of N�V �M ►3Ei2 20 2L4 Notary ub is TIMOTHY LEITCH NOTARY PUBLIC STATE OF NEW YORK SUFFOLK COUNTY PROPERTY OWNER AUTHORIZATION LIC.#01 LE0024350 (Where the applicant is not the owner) COMM. EXP. soa I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 \ \$ " OR \\ \\ \\\\ \\\\\ \\ p \ N. \\ ` O Suffol \\ k County Dept. of, � Labor Liconsing A Consumer Affairs \\° \" N HOME {MPROVEM'ENT LICENSE _ Name - - �— �? _ ANTHONY GONZALEZ � �� '' � ��;�� Business dame , - cz @ TD COUNTY WIDE CONTRACTING INC N This cor tAos that the y _ O *�., tearer duly I►cens%! License Number H-46712 N O by the County of sutlolk Issued- 1010112009 - _ z O 04 i R sc�C .eA�ragcr- Expires: 10101/2025 i d > Commissioner 0 O y��\` ". J z Q \\ O � � \\� ''^^ New workers' CERTIFICATE OF INSURANCE COVERAGE s°are Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carr'te 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured TD COUNTY WIDE CONTRACTING INC 631-827-0661 11 HORSTEAD COURT YAPHANK, NY 11980 1 c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required ff coverage is specifically limited to 800471583 certain locations in New York State,i.e.,Wrap-Up Policy) 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint We Insurance Company TOWN OF SOUTHOLD 3b.Policy Number of Entity Listed in Box"I a" 54375 ROUTE 25 DBL332860 SOUTHOLD,NY 11971 3c_Policy effective period 01/21/2024 to 01/20/2026 4. Policy provides the following benefits: A.Both disability and paid family leave benefits. B.Disability benefits only- C.Paid family leave benefits only. 5. Policy covers: g] A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. 0 B.Only the following,class or classes of employers employees: Under penalty-of per)uryw I cert4 that I am an authorized representative or licensed agent of the insurance carrier referenced aboia and that the Warned insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 11/12/2024 By Si ature of insurance tamers authorized representative or NYS Ucensad Insurance Agent of that ( p insurance carrier) Telephone Number 516-829-8100 Name and Title LeSton Welsh Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carriers authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 46,4C or 56 is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit,PO Box 5200,Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(Only If Box 4B,4C or 55 have been checked) State of New York Workers' Complensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed BY (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note.only insurance carriers libensedlo write @IYS disabilily and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are autliodked to issue Form DB-120.1.insurance brokers are NOT authorized to issue this form, DB420.1 (12-21) I�I�� � 1�2� .riiiiii1Ainii ii��� Additional Instructions for Form 10113-120.1 By signing this fbrm,the insurance carrier Identified in Box 3 on this form is certifying that it is insuring the business referenced In Box I a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law, The insurance carder or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within!30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Ceffificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration,date listed in Box 3c,whichever is earlier. This Certificate is issued as a matter of information only and confers no rights upon the certificate holder.This Certificate does not amend, extend or alter,the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This Certificate may be used as evidence of a NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this form, if the business continues to be named an a permit,license or contract Issued by a certificate,holder,the business must provide that certificate holder with a now Certificate of Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof'that the business is complying with the mandatory coverage requirements of the NYS,Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this arficle and notwithstanding any general or special statute requiring or authorizing any such,contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced In a form satisfactory to the chair, that the payment of disability benefits and;after January first, two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (12-21)Reverse STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured TD COUNTY WIDE CONTRACTING, INC (631)827-0661 11 HORSTEAD CT YAPHANK,NY 11980 lc.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required(coverage is specifically I ld.Federal Employer Identification Number of Insured lindled to certain locations in New York Male, 4a, a Wrap-Up or Social Security Number Policy) 80-0471583 NEW YORK 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) the hartford-agency resources/phs TOWN OF SOUTHOLD 3b.Policy Number of entity listed in box"la" 54375 ROUTE 25 13 WECBH 8216 SOUTHOLD,NY 11971 3c. Policy effective period 1/21/2024 1/21/2025 to 3d. The Proprietor,Partners or Executive Officers are included. (only check box if all partners/officers included) Q✓ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"Y' insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(ice must be listed under ltcrn 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed abovc as the certificate holder in box"T' °l sae insurance Carr~ier will also note the above certificate balder within 10 days IF policy is canceled clue to nonpayment cif;,reiniiuns or within.ICI clays Ili"iliere are reasons other than nonpayment of p1,enmuns that cancel the policy or eliminate the insured from the cou rage indicated o i tltry Cer/ilicale. (these notioe ina be sent by regu nlar oil,) Otherwvise,this Certificate is valid for one year after this,jor a is approved by the insurance carrier or its licensed agent,or until the Policy expiration date listed in box"30,whichever is earlier: Please Note. Upon the cancellation of the workers' compensation policy indicated;on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authori7 d proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that l am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. THOMAS WATSON Approved by: (Print name of authorized representative or licensed agent of insurance carrier) 11/12/2024 Approved by: 1Z (Signature) (Date) BROKER Title: 631-281-1700 Telephone Number of authorized representative or licensed agent of insurance carver: Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department,board,commission or office authorized or required bylaw to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,and notwithstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue suclt permit unless proof duly subscribed by an iaa a rance carrier is produced in a form satisfactory to the chair,that compensation for all eanpioyees Maas been secured as provided by dais chapter, Nothing herein,however„shall be construed as creating any liability on the part of such state or municipal department,board, commission or,office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department,board,commission or office authorized or required by law to enter into any contract for or in connection with any work in the employment of employees in a hazardous employment defined by this chapter,notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-07)Reverse ZNOEO"wercworkers•T CERTIFICATE OF INSURANCE COVERAGE X nsation NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured TD COUNTY WIDE CONTRACTING INC 631-827-0661 11 HORSTEAD COURT YAPHANK, NY 11980 1 c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required It coverage is specifically limited to 800471583 certain locations in New York State,i.e.,Wrap-Up Policy) 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD 3b.Policy Number of Entity Listed in Box"1 a" DBL332860 54375 ROUTE 25 SOUTHOLD,NY 11971 3c.policy effective period 0 1 121/20 24 to 01/20/2026 4. Policy provides the following benefits: © A.Both disability and.,pent family leave benefits_ B.Disability benefits only, C.Paid .' Tamil leave benefits only.Y 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law- B.Only the fallowing class or classes of employers employeev Under�Zenalty of pe ury,1.certify ttlat l am an au.nonaed reprasa ntative or licensed agent laf the insurance carrier referenced above and that the named insured has NYS Disability andlor Paid Family Leave Benefits insurance coverage as described above. 11/12/2024 14"—f Date Signed BY (Signature of insurance carrier's authorized representative or NYS Ucensed Insurance Agent of that insurance carrier) Telephone Number 5—- 29-151100 Name and Title LeSton Welsh Chief EXeicutt C Officer IMPORTANT: tf Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 4B,4C or 513 is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law.It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200, Binghamton,NY 13902-5200_ PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4B,4C or 5B have been checked) State of New York Workers"Compensation Board According to information maintained by the NYS Workers"Compensation Board,,the above-named employer has complied With the NYS Disability and Paid Family Leave Benefits Law(Aiticle 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed BY (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance poll es and NYS tic ensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1_Insurance brokers are NOT authorized to issue this form. D13_120.1 (12.21) IIIII ' ' iuiiu � i Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law. The insurance carder or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the Insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c, whichever is earlier. This Certificate is issued as a matter of Information only and confers no rights upon the certificate holder.This Certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This Certificate may be used as evidence of a NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this form, If the business continues to be named on,a permit,license or contract Issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein„ however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after,January first,two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. D13-120.1 (12-21)Reverse I a Lot 21 Z_ C� J90.7'13" -- II (A ro CL e:Ytw b 4 sad 113 9tr� Q NQ 01- O r o'7 "IQ 001 AtP^ _ a L � mot 0 SURVEY FOR SOF'FtYl.lf MdWY DEPARNEW OF HEUTH MWZ JOHN PARASKEVAS S E FAMILY"DWELLING 47NLY LOT 19 °HIGHPOINT AT EAST MARION, SECTION I" NOV 3,1987 CATE"� � 'Mt#S REF NO 3 AT EAST MARION DATE SEPT 4,1986 The sewage disposal and water supply facilities for tM TOWN OF SOUTHOLD SCALE I"=50' prwcAwnglm beemospeciedUylpsmNpattr otantl/Dr SUFFOLK COUNTY, NEW YORK NO B6- 969 Bureau of Wastewater Ma ION L OR ADDITION ro THIS Chief nd(u tD tir ter 4000PIES OF TMIS"VE 6 mr a I Cae -SURVEY TNOIA O TIONALTE O �� dA �� SURVEY 6 A VIOLATION M SECTION 1203 OF THE L 'i NEW PORK STATE EDUCATION LAW OF N>e�,. NOT BEARING SEAL SHALL THE LAMA I, ..•-^" SURVEY C H INNER SEAL OR VALID R SEA N DUNO 1�NTEES OIN IDICATED HEREON SHALL ERUN PONLY TO Q3'RD W *C8 G HEALTH DEPARTMENT-DATA FOR APPRONDL 70 CC0457RLtlC7 THE rcasa+FOR WHOM ro THE IS PREPARED AND QI HIS BEHALF THE TITLETITLE COMPANY,GOVUIN- M NEAREST WATER SIAy N MY • HSgUMiCE OI WATERS INWtWITE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED M SI/F CO TAX MO. gliT', G,SE CTBON-=L KOCK..WQdL_'LOT 01! HEREON, AND TO THE ASSIGNEES OF THE LENDING p �C MTNERE AIM NO OMELLDMS WITNIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE Y ,- OTHER THAN THOSE 5NOWN HEREON TO ADOITIOMAL INSTITUTIONS OR SUBSEQUENT R THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS ROIOENCE M DNSTA ICES SHOWN HEREON FROM PROPERTY LINES " WILL CONFORM TO THE STANQARDS OF THE SUFFOLK COUNTY DEPARTMENT TOEXISTING STRUCTURES ARE FOR •SPECIFIC OF HEALTH i[RVICCi PURPOSE AND ARE NOT TO BE USED TO ESTABLISH APPLICANT, PROPERTY LINES OR FOR THE ERECTION OF FENCES w�, ANO yr�SO ADDRESS m�.....a.....,........ YOUNG & YOUNG 4RIVI OR3 F hVt'NTE 14• MONUME,N7 �a-SIAK.: '�,r-yT SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN IN YOUNG,PROFESSIONAL ENGINEER SUFFOLK COUNTY ON JAN.11,1984 AS FILE NO 7680 AND LAND SURVEYOR N YS LICENSE NO 12845 qk ? *? HOWARD W YOUNG, LAND SURVEYOR ,F�1 9g6 k N THE LOCAA LICENSE'K0*tWO..L(w1,SFpTlq TAN'N•••.fa713 cElaP'q-DclK.Y•y SHOW"HEREON NYS LICE NO 4589.1 �p ARE FRNaM FNELD GYFSE'R TIOWS AND ON DATA OSTAMSD fft"OTHERS IDNL✓ A O,. PRAM01%A SON,INC 1046 A op