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37267-Z
zrfF0 Town of Southold Annex EFOL,fcOGy 11/21/2012 P.O. Box 1179 co k 54375 Main Road N = oy � � Southold,New York 11971 O , CERTIFICATE OF OCCUPANCY No: 36052 Date: 11/21/2012 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 505 N Smith Dr, Southold, SCTM#: 473889 Sec/Block/Lot: 76.4-20 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 5/9/2012 pursuant to which Building Permit No. 37267 dated 6/1/2012 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: inground swimming pool fenced to code as applied for. The certificate is issued to McLaughlin,William&McLaughlin,Irene (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 37267 8/3/12 PLUMBERS CERTIFICATION DATED ,AIyrizedXignatde ��a" TOWN OF SOUTHOLD �g11FFo(,�CO�y BUILDING DEPARTMENT y z ' TOWN CLERK'S OFFICE oy • o� 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#: 37267 Date: 6/1/2012 Permission is hereby granted to: McLaughlin, WiIIMam & McLaughlin, Irene 295 Carnation Ave Floral Park, NY 11011 To: remove rear deck and install inground swimming pool fenced to code as applied for At premises located at: 505 N Smith Dr, Southold SCTM # 473889 Sec/Block/Lot# 76.-1-20 Pursuant to application dated 5/9/2012 and approved by the Building Inspector. To expire on 12/1/2013. Fees: DEMOLITION $136.00 SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $436.00 Building Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. 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 2/10 of 1% 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 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$50.00, Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool $50.00, Accessory building$50.00, Additions to accessory building$50.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy -Residential $15.00, Commercial$15.00 Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: House No. Street Hamlet Owner or Owners of Property: La_(A t!'l C/m , Suffolk County Tax Map No 1000, Section Block Loth Subdivision Filed Map. Lot: Permit No. � 1 o>1 6--7 Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) c� Fee Submitted: $ Applicant SAqgnatugre SO!/j�olo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 roger.richertO-town.southold.ny.us Southold,NY 11971-0959 C4UNTY,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: McLaughlin Address: 655 Smith Dr North City: Southold St: NY Zip: 11971 Building Permit#: 37267 Section: 76 Block: 1 Lot: 20 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Raymond Electrical Cont. License No: 5141-me SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 2 Twist Lock Exit Fixtures TVSS Other Equipment: in ground swimming pool , to include, bonding, 1-GFC1 circuit breaker 1-pool light, 1-gas pool heater Notes: Inspector Signature: ce �Q Date: Aug 3 2012 81-Cert Electrical Compliance Form.xls FIELD INSPECTXON REPORT DATE COMMENTS uj FOUNDATION(1ST) IE --- ------------------- FOUNDATION(M) • ROUGH FRAMING& UN PLUMBING i • G G� INSUL•ATION PER N.Y. STATE ENERGY CODE C • y � C ®.1 FINAL J ADDITIONAL COMMENTS tibc 3 17, � z r rn TOWN OF SOUTHOLD v BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX: (631)765-9502 2 Survey SoutholdTown.NorthFork.net PERMIT NO. J Z„Zg Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined CO6 20� Storm-Water Assessment Form Contact: Approved 20t�L MailgW:— Disapproved a/c 471 Route 25A Ang Point, NY 11778 Expiration ,20 c Building Inspector APPLICATION FOR BUILDING PERMIT Date 20 INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 waterways. 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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning,amendments or other ra-g-Ar"ons affecting UiC property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. 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. 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 for necessary inspections. r.O CURANC�` OR L 71MIAEDIATf LN -1, j ENCLOSE POOL TO'CODEU +� U N LA U y U (Signature of applican or n ,if a corporation) �J.GOMPLET(O � ��°w t` HC UY CERTI�;i A - .a5 rnC h®►� � i r (Mailing address of applicant) O ' CCUPANICY �l0(,�d90,v'v- N,/ 1 IC� Ic� State whether appliNantl is--owner � gent, architect, engineer, genera l�c trft, �ectgir a , b r builder Fe : (`Id �3U!LDING DE ARTMENT AT Name of owner of premises re— I1Fy�?G5-tea2- S AM TO 4 PM .FOR TH9 (As on the ax roll or lat st d' , If applicant is a corporation, signature of duly authorized o i 6 cer ! 1K ION TWO REQUIRED �Z �oURED CONCRETE , 2- C<DUG1{-FRAMING,PLUMBING, (Nacre and title of corporate officer) STROPPING,ELECTRICAL&CAULKING! 3. INSULATION Builders License Noe? 4. FINAL-CONSTRUCTION 8 ELECTRICAL' Plumbers License No. MUST BE COMPLETE FOR C.O. AIL CONSTRUCTION SMALL MEETTME Electricians License No. INSPECTION REGMEDR-vwt REMENTS OF THE CODES OF NEW Other Trade's License No. YO RK STATE. NOT RESPONSIBLE FOR :DtSIGN CO TRU�N E"R g. 1. Locat�or},of land on>vhieb Droposed work will be done: Sb1�l I }�� C� house Number Street Hamlet County Tax Map No. 1000 Section Block l Lot Subdivision Filed Map No. TA'p4i UFT. OF THE TOWN CODE. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy i b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal DeWlition K Other Work ,.,- tr tev !� (Description) 4. Estimated Cost Fee �- (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor 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 structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated 12.Does proposed construction violate any zoning law, ordinance or regulation?YES No/—�c 13, Will lot be re-graded? YES NO Will excess fill be removed from premises?YES NCX 14.Names of Owner of premier Mrip ' cr ss _ Phone Nb?)(0-7-7� -7q Name of Architect (� oVl �l ddress Phone No 331 -Z-P Name of Contractor AddressW?l Rb. ZSA} Phone No.9 -744- loZ 15 a. Is this property within 100 feet of a tidal wetland or a freshwater w tland? *YES N04_ * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey, to scale,with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property? * YES NOX— * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)a ov named, (S)He is the 0 USIA QIr (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 knowledge and belief,and that the work will be performed in the manner set forth in the application filed therewith. Ss before me thi d y of 20�5 \ N MYPUB1tC STATE OFII�VW 7 . coumff Notary Public 11C, 01I1 Signature of Applicant ,, o��pF SO�jyo Town Hall Annex 54375 Main Road � � Telephone(6811))7655--11802 CO2 P.O.Box 1179 • ba roaer.richerKa' ilAn 076UVold ny us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: a y j�Gc Date: 2 Company Name: C �J Name: Ila 1 ' License No.:r1 Address: &' 142, `��,�-�-,r. Phone No.: (o'j ► (o —S7 3 1-7g JOBSITE INFORMATION: (*Indicates, required information) *Name: *Address: J.5 �+ '� *Cross Street: al n Q *Phone No.: Permit No.: -7 o7, /o `7 - Tax Map District: 1000 Section: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) ro 1Sw- (Y); n 1rin (Please Circle All That Apply) *Is job ready for inspection: YES NO Rough In Final *Do you need a Temp Certificate: YES 4DO Temp-Information(If needed} - *Service Size: 1 Phase .3Phase .100 ISO. 200 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additionallnfonnation: �- PAYMENT DUE WITH APPLICATION j np DDIEC E 0 U E Town of Southold - Chapter 236 - Stormw, W1ha?�f1�nt N � Z 01u SWPPP - Storm Water Pollution Prevention Pla A BLDG.DEPT. GENERAL INFORMATI Requested Information is Required fc pomp e e pp cation A P T N Agen - onsulta -Contra to r the (Circle One) Property OW NE WDiffe nt than Applicant) Address: � ress: Telephone .L-L Fax#: G Telephone#: 4 ax l J E-Mail: I E-Mail: Property Address: Q , Brief Description of Construction Activity,Proposed Struchual BMPs,Soil v Stabalization BMPs,Project Scope and/or Sequence of Construction Activity District I (Provide Additional Pages as Needed) Section Block Lot ' Name ofCojoactor and/or C ntact Perso espons le for I Iplementation of SWPPP: -------------------------------------------- n0- Address: r ---------"------------------------------------ V)Il Telephone#: ____ _________, _ ___ ___-_.____."_____________ E-Mail• ti - --- --- -of/-J- Name of Persons Responsible for Installation&M Intenance of Erosion Control Practice: ----------------- Address: Y Telephone#: Fax#: E-Mail: Total Area of All Total Area of Land Clearing Project Parcels: and/or Ground Disturbance: ____________ -- ______ (S,F. AA.) (S.F.I A—) I Project Duration: Start End -- .-------.--______________-_-__------_____ (Anticipated) Date: Date: _ (Number of Calendar Days) Will this Project Disturbe five(5)or More Acres at Any One Time During the Proposed Development? Yes -------------•------------------..____ If YES:Please Answer the Followingl ----------------- -------------------------- a. Does the Applicant have a Qualified Inspector On 0 Q I Staff To Conduct the Required Inspections? Yes No b. Does the SWPPP Indicate How Frequently the Site O List the NAMES or description of all Potentially Impacted Waterbodies and/or Wetlands: Inspections will Occur and for What Period of Time? Yes No c. Does the SWPPP Adequately Identify All Temporary _._-_-_---_----.-__.------------------_ Q Q and/or Permanent Sol[Stabalization Measures? Yes No "--"""--"-------------------------------- d. Does the SWPPP Adequately Identify a Complete Q Q _.................._.............__..._..._._.._.__...._._..--'--_--------_._.._-- Project Phasing Plan? Yes NO Status of Impacted Waterbody:(eq.TMDL,303(d)Listed,Impaired...) e. Does the SWPPP indicate Additional Site Specific 0 Practices that Will be'Utilized to Protect Water Quality? Yes No ..........................................._...._....._...... - f. Has the Applicant Submitted a Completed DEC Notice Of Intent and SWPPP Acceptance Form for Review O Type of Impacted Waterbody:(eq.Lake,Creek,Bay,Pond,Sound,Freshwater Wetland...) by the Town of Southold? Yes No j STAI-F;OF NEW YORK, F.............................. .......... S 'That I,...C.COUMFTY . �^ nn � I idu T. . ... 4� ,rl tll sworn,deposes and says that he/she is the applicant for Permit, ........ .. ..... ....... (Name of individua signing D cuin Andthat he/she is the ... . .: .. .. .............................................................:.. ", .............................. -( ner,Con lor, geA nt,Corporate Officer,etc.) Owner and/or representative of the 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 ontained in this application are true to the best of his knowledge and belief,and that the work will be performed i e manner (h• Sworn to b e this; 199ttt0lr'�11 r .... O � EY17t R/771f W Notary Public: ......... ... .... ........ A M3PI f0 31Y1S'JI1811d,�lIV1aN . (Signature f pplipn SWPPP Assessment FOR : 03-12 i TOWN OF SOUTHOLD 090PERTY RgCORD CARD OW l�1G � STREET c� VILLAGE DISTRICT SUB. LOT • + 1 FARMER OWNER N E ACREAGE ,♦ rl Sm,W a Ono) t S W _ TYPE OF BUILDING . RES. SEAS. VL. 71FA7R7M comm. � IND. � CB. � h1ISC. � Est. Mkt. Value LAND IMP. TOTAL' DATE REMARKS Rae Boo 8 G'oriK weaX-- � - o . i�•C `4j4a S S'G� S o �� S S�-� f 41 958' 11 r�8 }-�nl�'11� S;I/s BUDING C Lim NORMAL 1fB E FRONTAGE ON WATER Form Acre V I e Per A e5 1©�Jtalue FRONTAGE ON ROAD f ODD Tillable 1 BULKHEAD f �p�. Til I a bl e 2 DOCK �� Z �5 ��I 1f S Tillable 3 T 3 Woodland Swarnp[and jY a Brushland i-House Plotvy Total l ..i /7.., nHDo /�A � k•= l l J b w �� �'r A t� �t k`f .es It 14 i xis •i I, � ! I i '. . • I ii � � �� I . I i I I i I I 4 1- i ! t I 1. Sld I I Foundation C eNG i Bath ?� 0244r ?? 'r d ! xtension Basement Ffaors xtensi ; �, 4 /d 7 3 z� �.s'/,�I Ext. VYc�[Is. I �,�,, 1 ,interior Finish c ' Fire Pfcce I h f� I H.ent x.ension I _ Porch ' i Roof Type ; f A I I A Zvi 10,5 1 Porch Rooms 1st Floor .I PatioRooms 2nd Floor 1 i reezeway I i ! Driveway 1 1 Donner ' ;orage 3 1.T- -is _ 3/.� / - 3/ ' ' I I � I �. B. °i 1 f SWIM KING POOLS MODMO) 471 Route 25A ROCKY POINT, NY 11778 LETTER (631) 744-3100 ��. Date. .............. ....................1 1 .............I........................................................................................... .......... r\ (� ......--...................................,........................................................... .............. To.................�.'Cvj.. .� _�..."�`.,............... ............................ Subject ......... ..�J.. ........................�.,1. ................. ................. ................. ❑ ❑.� ................................................................................ M��.Lau1 1 �► ..... ... .. .. .. . . . . �9 ..........................--.................................................................................................................................................................................................................................................................................................................................................................................................... ' ... .. -c a..... i . .. .. .._1 �._�.. ........................................... ... ... .......................................................................................................... ................................................................................................................................................................................................................................................................................................................................................................................................................................... ..................... d..................�.. ................... ................... ..v .........................._ _C ...................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................................................................................................................................. �- _ � ... .o u�.1.._1......................... ............................................................................. .......... .................................................... ........... .............................. .... . �.................. ......................I ......................... �..................... C � _� _ ❑ ....................................................................................................... ..... .. .. . .................................................................................................................................... D.. .AY.......3...0......2012.............. ....................... BLDG.DEPT. ............................................................................................................................................................................................................................................................................................. TOWN OF SOLTHOL.D............................................... SIGNED ElPlease reply ElNo reply necessary CHECK VALVE PUMP FROM SKIMMER ^� V Z co O LULi r } (J v Z Lu A 4 TO DI5POS z Q z DRYWELL 10 5' 8' 5' 18' CN p Lu DEEP WATER RETURNS G Z � V o� VAVLEV �R 0 Q O O V11 d r1 FI LTER 0 �- m 1Z POURED CONCRETE WALLS AND STEPS r• TO RETURNS l E B PLAN CHECK VALVE""""""' i8 PLUMBING SCHEMATIC WALLS AND STEPS AIR? in to 4 SAND BOTTOM c ,� O ,S COPING AND WALKWAY' OF��� i (BY OTHERS) SECTION A NOTES o ; WATER LINE p, u s } GRAD 1• ALL CONSTRUCTION 15 TO BE IN ACCORDANCE WITH THE RESIDENTIAL CODE OF p o Z \\\ NEW YORK STATE-2010 AND THE ANSI/NSPI-5-03 STANDARDS FOR RESIDENTIAL TOP OF WALL INGROUND SWIMMING POOL5 FORA TYPE II POOL. � si�� "C7 WATER LINE 2 ��/� 2. STRUCTURE IS DESIGNED FOR USE BELOW GRADE AND ONLY IN AREAS WHERE THE v O ROLLED FOAM BETWEEN //\ GROUND WATER TABLE IS A MINIMUM OF 4 8 BELOW THE PROPOSED FINISHED GRADE. 4 VARIES 4 LINERAND CONCRETE \� 3. BACKFILL WITH CLEAN EARTH,FREE OF ROOTS AND DEBRIS, DO NOTALLOW THE HEIGHT 0 FORM TIES �/ OF BACKFILL TO EXCEED THE HEIGHT OF THE WATER IN THE POOL BY MORE THAN 8'; C� Ln O \\\ OR THE WATER TO EXCEED BACKFILL BY MORE THAN 8'. CS, s �O N 3500 PSI POURED CONC. a /�� co 4. PLACE CONCRETE ON SANDY TO LOAM SOIL REMOVE ANY CLAY DEPOSIT AND COMPACT CLEAN BACKFILL. 2"RETURN LINE a 0 5. WALKS TO BE SMOOTH,NON SKID TYPE,SLOPED AWAY FROM POOL W >" VINYL LINER /\\/ b. WATER DISPOSAL SHALL BE LIMITED TO OWNERS PROPERTY IN ACCORDANCE WITH Z cn Z Z 4 \\� LOCAL REGULATIONS Q U W Z O //�i 7, PROPERTY OWNER 15 RESPONSIBLE TO INSTALL PERMANENT FENCE AROUND POOL V)IN ACCORDANCE W Lil O<- SECTION B 2 TO 4"SAND //\ PERMANENT ENC OITH SURE MUST BE COMPL TTHE NY5 BUILDINGOED WITHIN NINETY AY55AFTERTHE DATE OF Z~Q �2 COMMENCEMENTOF CONSTRUCTION. \\/\\/\\ \\/�\\ \\ \\ \\ \\ \\jam 8 5 THERE 15 DED Y TIHEDSKIMMERS THIS POOL. MEETS REQVIREME POOLNT5 OFR C-S CTION AC p eL FOR ENTRAPMENTPROTECTION, J Q Ln 9. TH15 POOL SHALL BE EQUIPPED WITH AN APPROVED POOLALARM WHICH 15 CLASSIFIED O BY UNDERWITERS LABORATORY, INC TO REFERENCE STANDARD A517M 2208 ENTITLED a- �/� "STANDARD SPECIFICATION FOR POOLALARM5,"ASADOPTEDIN 2008. c 10 THROVGOHOUTENCLOSURE, HE PE PERIOD OF OFR 4 FT CONSTRUCTION OF TINSTALLED E SWIMMING AND REMAIN , IN PLACE 5-2_12 WALL SECTION UNTIL TH E COMPLETION OF A PERMANENT ENCLOSURE. - - 3 Stt�•d�YE�s �o� �0��6L'� '3'aO�.�R __, j� � l��4 P�2-i"Y •1�.off.tea'►"E L� A.T �1`.. 1�!��.� - � ru 1 L E t> &I C>-,,/. Z'Z b aJ 4 F 1 L-e Ai l= �1"ou.Jt+.A o� S�LlTt-kz�i..p f ✓ - { 0 NMCA IV �_- let- ki fol wl 1 SCF�QIi� CE}ilN:Y DEPARTS IR.1i OF mAILTH .saloicis T• = — 'S , �Q �C9 � _ A\ — — = -ag as- OT CmTpurnaw ate r�_� Z=—=Z � 'V � NEW DATE KS RFF No Lf4>-r 1 Z� ru 4 APPiti}RffQ yv� � �� SJ-S /1 i� j -t R) this''ve§4 cr �I. t o to f6- sfanjap& of �Ja. MAY 3 0 2012 BLDG.DEPT. TGWN 114 OF SGU