HomeMy WebLinkAbout23500-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24576 Date August 16, 1996
THIS CERTIFIES that the building addition
Location of Property 120 Richmond Road, Southold
House No. Street Hamlet
County Tax Map No. 1000 Section 51 Block 6 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated May 16, 1996 pursuant to which
Building Permit No. 23500-Z dated June 13, 1996
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 deck addition to existing one family dwelling as applied for.
The certificate is issued to Konstantinos Koukounas
(owner, lessee or tenant)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
FORK NO. 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)
N° 23500 Z Date ................. / ........................., 19 &
Permission is hereby granted to: J
— 3 : :.... ...f%: ..................................
A FF1. . . .........rIM3........
to ..... 'i.: ............... ...............::...... . ............ .......1` ...........................
atpremises located at ........ ........ f:?'kr ?�f. .................................................................
.................................................................... �a.. ..�..............................................................
.................................................................................................................................................................
County Tax Map No. 1000 Section .....k�7........... Block .......,,t26L Lot No. Z!�.r..........
pursuant to application dated .......A11 ... .....1k....................... 194 ., and approved by the
Building Inspector.
Fee $e7Q.-- ..
u
ilding Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
r�4s ,
TOWN HALL
765-1802 AUG 13 1996 1'ILL
I
JEs�T
APPLICATION FOR CERTIFICATE OF OCCUPANCY BLD—
TOWN OFSOUTi.OLD
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 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.
r
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.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - .25v�.
4. Updated Certificate 'of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential 15. 0, Commercial $15.00
Date . . �!. . . . . . ./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . Old Or Pre-existing Bui in . . . . . . . . .
Location of Property. . . . G.'. L.o . . . . . . . . . . . . . . . . lC l.%'1.�. . . . . . . . . . . . . . . . . . . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property. . . �:'d 5 :1. �?�S . . . . . �� .v .�1.�. . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . ./. . . . . . .Block. . . . . . . . . . . . .Lot. . . ./5. . . . . . . . . . . . . :
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. .. . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . .. . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . .LZ4
--
bi 7�' . . . . . . . . . .�. . . . . . . . . . . . . . . . . . . . . . . .
�� 45_7� APPLICANT
r tilt I UA I I.
..................
NY)
FUMIDATI 011
----------------- ----------
Xa
ROUGH & ...........
.................. C)
..........
---------------------.,ma,- --
----------
..........
if . ...............
1 II
STATE
1;1 IIAL
BILL OF' MATERIALS --- LUMBER
CUSTOMER: GUS KOUKOUNAS
DATE: 05/11/96 REF: GUS1
SALESMAN # BUCKY
---------------------------------------------------------------------------
COMPONENT SKU QUANTITY DESCRIPTION WOOD TYPE
---------------------------------------------------------------------------
DECKING 7054X06X10 95 EA 5/4X6 10' PRE CCA
DECKING 7054X06X08 25 EA 5/4X6 8' PREM .CCA
DECKING 7054X06X16 4 EA 5/4X6 16' PRE CCA
RAIL CAP 702X06X08 8 EA 2XGX8 CCA CCA
HORIZONTAL RAILS 702X04X16 9 EA 2X4X16 CCA CCA
HORIZONTAL RAILS 702X04X08 1 EA 2X4X8 CCA CCA
VERTICAL RAILS 701X04X12 42 EA 1X4 12' CCA CCA
RAIL POST 704X04X16 6 EA 4X4X16 CCA CCA
STAIR POST 704X04X16 1 EA 4X4X16 CCA CCA
STAIR STRINGER 702X12X18 2 EA 2X12X18 CCA CCA
STAIR TREAD 7054X0GX10 6 EA 5/4X6 10' PRE CCA
BEAMS 702X10X18 2 EA 2X10X18 CCA CCA
BEAMS 702XIOX10 1 EA 2X10X10 CCA CCA
BEAMS 702XIOX12 4 EA 2X10X12 CCA CCA
JOISTS 702X10X10 3 EA 2XIOX10 CCA CCA
JOISTS 702X10X12 31 EA 2XIOX12 CCA CCA
J-SPLICE 702X10X14 2 EA 2XIOX14 CCA CCA
FASCIA• 702X10X14 1 EA 2X10X14 CCA CCA
FASCIA 702X10X08 3 EA 2X10X8 CCA CCA
FASCIA 702X10X18 1 EA 2X10X18 CCA CCA
. FASCIA 702X10X12 1 EA 2X10X12 CCA CCA
LEDGER 702X10X14 1 EA 2X10X14 CCA CCA
LEDGER 702X10X08 3 EA 2X10X8 CCA CCA
LEDGER 702X10X18 2 EA 2X10X18 CCA CCA
LEDGER 702X10X12 3 EA 2XIOX12 CCA CCA
STAIR HANDRAIL/CAP 702X06X18 1 EA 2X6X18 CCA CCA
HORZ. STAIR RAILS 702X04X16 3 EA 2X4X16 CCA CCA
VERT. STAIR RAILS 701X04X12 24 EA 1X4 12' CCA CCA
GROUND POSTS 704X04X10 5 EA 4X4X10 CCA CCA
---------------------------------------------------------------------------
OCCUPANCY OR R.
USE IS UNLAWFUL
WITHOUT CERTIFICATE;
OF OCCUPANCY
BILL OF MATERIALS --- OTHER MATERIALS
CUSTOMER: GUS KOUKOUNAS
DATE: 05/11/96 REF': GUS1
SALESMAN # BUCKY
---------------------------------------------------------------------------
COMPONENT SKU QUANTITY DESCRIPTION
---------------------------------------------------------------------------
JOIST HANGER, 10IN 40244 42 EA 10" GALV. HANGER
JOIST HANGER NAILS 50275 6 BAGS KANT SAG NAILS
BEAM BRACKET 40257A 6 EA PB44 4X4 POST BEAM CAP
16D NAILS 50055 29 LBS 16D GALV. NAILS
10D NAILS 50051 3 LBS 10D GALV. NAILS
8D NAILS 50049 17 LBS 8D GALV. NAILS
LAG SCREW 861270L 15 EA 1/2"X7" LAG SCREW
WASHER 8612W 203 EA 1/2" WASHER
TIE-DOWN STRAP 40236 76 EA JOIST TIE-DOWN STRAP
RAILING BOLT,6IN 861260C 54 EA 1/21IX6" BOLT
NUT 8612N 94 EA 1/2" NUT
ANCHOR BOLT 861280A 10 EA ANCHOR BOLT FOR POST
FOUNDATION BRKT,4X4 40264 10 EA GALV. POST BRACKET,4
SONO TUBE 22926 4 EA 8"X 42" BUILDERS TUBE
CONCRETE,80LB 2223 51 BAGS CONCRETE, 80 LB BAG
---------------------------------------------------------------------------
BILL OF MATERIALS
CUSTOMER: GUS KOUKOUNAS
DATE: 05/11/96 REF: GUS1
SALESMAN # BUCKY
UNAVAILABLE COMPONENTS
----------- ----------
NO SKU FOR COMPONENT [BEAM BOLT,8IN] - 40 REQUESTED
---------------------------------------------------------------------------
SUMMARY
---------------------------------------------------------------------------
LUMBER MATERIALS $ 2283 .88
OTHER MATERIALS $ 491.74
TOTAL $ 2775.62 (556.00 SQ FT, $4.99 PER SQ FT)
---------------------------------------------------------------------------
WOOD TYPES USED IN DECK
DECK PLANKS .40 CCA
STAIR TREAD .40 CCA
STRINGERS .40 CCA
JOISTS .40 CCA
FASCIA .40 CCA
LEDGERS .40 CCA
BEAMS .40 CCA
GROUND POSTS .40 CCA
RAIL POSTS .40 CCA
RAIL CAPS .40 CCA
RAIL SPINDLES .40 CCA
OTHER RAIL MEMBERS .40 CCA
---------------------------------------------------------------------------
TO COMPLETE YOUR DECK THE FOLLOWING TOOLS ARE REQUIRED:
CIRCULAR SAW HAMMER CRESCENT WRENCH
CHALK LINE RAFTER SQUARE 2' LEVEL
CEMENT TROWEL MEASURING TAPE SHOVEL
WHEEL BARROW BRACE & BITS
---------------------------------------------------------------------------
STRESS ANALYSIS
CUSTOMER: GUS KOUKOUNAS
DATE: 05/11/96 REF: GUS1
SALESMAN # BUCKY
-------------------------------------------------------
MEMBER STRESS FACTOR COMPOSITE
TYPE SIZE FACTOR LOAD LOAD
-------------------------------------------------------
JOISTS 2X10 DEFLECTION 124 PSF
16IN BENDING 97 PSF
SHEAR 125 PSF
COMPRESSION 165 PSF 97 PSF
BEAMS 2-2X10 DEFLECTION 210 PSF
BENDING 80 PSF
SHEAR 61 PSF
COMPRESSION 158 PSF 61 PSF
BOLTS 1/2IN SHEAR 1492 PSF 1492 PSF
POSTS 4X4 STABILITY 288 PSF 288 PSF
-----------------------------------
TOTAL LOAD 61 PSF
DEAD LOAD 10 PSF
LIVE LOAD 51 PSF
-------------------------------------------------------
STRINGER 2X12 DEFLECTION 85 PSF
BENDING 92 PSF
SHEAR 127 PSF
COMPRESSION 534 PSF
-----------------------------------
TOTAL LOAD 85 PSF
DEAD LOAD 10 PSF
LIVE LOAD 75 PSF
-------------------------------------------------------
O
PLAN VIEW RIVERHEAD BUILDING SUPPLY
CUSTOMER -- GUS KOUKOUNAS ROUTE 25
DATE 05/11/96 REF GUS1 GREENPORT, NEW YORK
29'
18, 11'
(U
(U
� N
N
(U
('U
4' 25'
LOAD AND SUPPORT: Your deck will support a 50 PSF live load. Posts have 36" below-ground
post support.
DECK AND POST HEIGHT: You selected a height of 60" from the top of decking to level ground.
The top of the deck support posts will therefore be 49.25" above ground level. Your salesperson
can provide information for uneven or sloped ground.
JOISTS: Set joists on top of beams, 16" center to center.
NOTE: The design may require knee braces and bridging between joists. Your materials list includes
the necessary items. The suggested design is not a finished building plan. You are responsible for
all measurements being correct, for verifying that the design (and any substitutions or modifications
that you make) meets all local building codes and requirements. To verify that the suggested design,
and any substitutions or modifications, is consistent with conditions at the construction site,
review the design with your architect. Also consult your architect for proper construction and use
of materials in the structure.
Be sure to follow the deck construction detail available from your store salesperson.
BEAM LAYOUT RIVERHEAD BUILDING SUPPLY
CUSTOMER -- GUS KOUKOUNAS ROUTE 25
DATE 05/11/96 REF GUS1 GREENPORT, NEW YORK
11' 11 1/4
Ai H j H i H 114 114 1 H T97
9' 6 1/2"
B
1' 6"
C
1' 1/4"
BEAM BEAM POST POST
LABEL LENGTH COUNT SPACING
A 17' 10 1/2" 4 5' 10 5/161,
B 4' 1 1/2" 2 3' 10"
C 23' 5" 4 7' 8 1/2"
Post spacing is measured center-to-center.
Depth of concrete footers --- 36 inches.
CUSTOM VIEW
CUSTOMER -- GUS KOUKOUNAS
DATE 05/II/96 REF GUSI
RIVERHEAD BUILDING SUPPLY
ROUTE 25
GREENPORT, NEW YORK
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN CATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE ell 150'�/ INSPECTO
BOARD OF HEALTH
Q 6 FORM NO. 1 -s- 3 SETS OF PLANS . . . . . . . . . . . . . . .
TOWN OF SOUTHOLD SURVEY
i( BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
MAY 11'6
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
BLDG.DEPT. } TEL: 765-1802 NOTIFY:
TOWN OF SOUTHOLD CALL . . . . . . . . . . . . . . .
Examined.... . ....... 19.�(D MAIL TO: .�Sr4N-�i.. . �. . ....
` 3 �Ll--�3- 3 5 5-1,,ee,-
.... ..., 19.(. Permit No. ...---... .... .. ..
Approved. .cp�l.. � .. ........................
Disapproved a/c .................................. .. J....G/`� ..
......................................................
(Building• n - tor)
APPLICATION FOR BUILDING PERMIT
Date. .
INSTRUCTIONS
a. Phis application mast 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 mast be drawn on the diagram which is part of
this application.
a 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
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. 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 f r nec sary inspections.
.....: .... .�.......................
-,: (Sigraatas o. applicant, or name, if a corporation)
-.......... ...................re .........
/fib
(Mailing address of applicant) •� C."�
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........(...rv ............. ...............................................:. ...............................
Name of owner of premises ..Aa'?S l 4-1 /i of GS �v��c� .:.......................................
............................
(as on the tax roll or latest deed)
If applicant is.a corporation, signature of duly authorized officer.
..........................................................
(Name and title of corporate officer)
Builders License No. .........................
Plumbers License No. .........................
Electricians License No. ............... ... /
Other Trade's License No. ....................
f
1. Location of land on which proposed work will be done..............................................................�
................................ .k:.............. .. ........ . ................6...........................
House Number . /-C� Street ( c 4�1 c /(' e Hamlet
County Tax Map No. 1000 Section ....�;../....... Block ....(�.......... Lot ...Z 5.......
Subdivision ...................................... Filed Map No. ............... Lot ...............
(Nape)
2. State existing use and occupancy of premises and intended/ and occupancy of proposed construction:
a. Existing use and occupancy ................................L�i e �e�........................................
b. Intended use and occupancy ................. ...
.... �c�tee........... ................. • .......
3. Pacure of work (dheck which applicable): New Ikuilding .......... Addition .: Al,tera'hon":::::
Repair ............ Removal ............. Demolition ............ Other Work
> (Descdpt ��_ s
4. Estimated CosL' J�, CCU v........ fee .......................................
(to be paid on filing this application)~-19 ''.s""
,; r*,ti
5. If &oelling, rxnber of dwelling units ............ tlortler of A-yelling units on each floor ................
If garage, rxniber of cars ......................................
6. If business, eonnercial or mixed occupancy, specify nature and extent of each type of use......................
7. Dimensions of existing structures, if any: Front................ Rear ................ Depth .................
height ......................... Norber of Stories ......................
Dimensions of sane structure with alterations or additions: Front ............... Rear ...............
Depth .................... height .................... Number of Stories ...............
8. Dimensions of entire new construction: Front ................ Rear ............... Depth ..............
lleiglht ......................... Umber of Stories .....................
9_ Size of lot: font Rear .................... Depth ....................
10. Date of Purdhase ..................... Name of Former Owner ........................................
II. Zone or use district in whidh premises are situated ... ...............................................
12. Does proposed ccxhstruction violate any zoning law, ordinance or regulation: (I/ J
..
13. Will lot be regraded .... v.......... Will excess fill be rermved from premises: YES l�
14. Nacres of Owner of premises . dtis .� `��s l""''v sAcklress a j....... Y. 3 Phone No. .....���: {
Name of Ardi test .................................... Address .............................. Phone No. ..........'h`...
Name of Contractor ................................... Address ...............................Phone No. ..............
15. is L1his property within 300 feet of a tidal caetland? * YES .......... NO
*IF YES, SCU11KND 1U4N 1RIJSM,13 PLilNrr MAY BE REQQIRMi .
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
from property lines. Give street and block mmber or description according'to deed, and show street- names and indicate h
Mietlher interior or corner lot.
APPROVED AS NOTED
DATE: A9 - B.P.#
OCCUPANCY OR FEE: BY:.
NOTIFY BUILDING DEPAR MENT AT
USE IS UNLAWFUL 765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
WITHOUT CERTIFICATE 1• FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
OF OCCUPANCY 2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
S[nIr Ole Nil1 DESIGN OR CONSTRUCTION ERRORS
ss
. 1.�.� �...:'cc:ko u -s
..__........lueinl; duly swonh, ,delxhses and says Lhat he is the applicant
(Mine of individual. signing contract) i
above' named,
Ileis Llhe .................. ...a. ..............__........................-........................
(ConLracto agent corporate officer, etc.)
of: said cm)er or owners, and is duly authorized to perform or have performed Lhe said work aril to make and file this
application; that all statements contained in this application are true to the best of bis knowledge arxl belief; and
Lhat Lbe work will be performed in the iminner set forLh in the application filed therewith.
Sworn to I F hr this �n
......... clay of ...�... .19.
Notary Phil is ... .-
n
..............................
CLAIRE L.GLEW i rkzture of- Applicant)
Notary Public„State of New York
No.4.879505
Qualified in Suffolk County
Commission Expires December 8,19
- The locations of wells and cesspools shown herson are from. Ie ,
The wafer supply and sewage disposal
observations and or from data obtained from others. rEsr *1
systems for this residence will conform moo H. S. # 89-SO-121 D,TAr
to the standards-of The Suffolk County- sEr ( a4m o�WN CLAYEY a.
Department of Health Services. PK i
COUNTOUR LINES AS SHOWN ARE PROPOSED BROWN LOAMY cLAY 2X.
BROWN CY.A Y V.
WA TM N BROWN
` ® I SUR VE Y OF WATER N BROWN
P = ! AEr" TO COARSE
SAND 14-
to 5 PROPERTY
IDA T SOUTHOLD
E #2
TOWN OF SOUTHOLD C" �°0."
fio� N i- CL4YEY LOAM !o"
z°'� UFFOL K COUNTY N. Y. BROWN LOAMY
BROWN TO MEULW
�o �� COARSE SAM
d 1000 51 - 06 - 15
N WA TO? BROWN MEWW
3 f Scale 1" = 4 0' To �DAR SAS
Sep t.�+ /141- 1988 WA TV?NBROWN
S9 FND 2T Sept 2�7, 19 9 (b.a 1 FINE N COARSE �.
ON c o S� V, TA r•. 51'
Jana 23, 199/(revise)B.O.K
�- Posr a 'pO 19920owxfW on)
.a•..x RAIL \ LP' � s • ': i2� \�' 9 j�� . . ,
FENCE AP,RE 24 1992(fatal.)
Q' a 3v a CAD TO
TICOR TITLE- GUARANTEE COMPANY
C1 SOUTHOLD SA VINGS BANK
- i pre AOELlK/ KOUKOUNAS
�o� Ffas Z KONSTANTWOS KOUKOUNAS
Vq
N/O/F JOSEPH H. SA W1CKI
( Tu
Zr-
— DEPARTMENT OF HEALTH.SERMES
DWELLING
act FOR APPROVAL of CONSTRUCTION ONLY
DATE HS REf.NO
0 FED 190'12 \ DWELLING 1 • -r vED
.......
N/O/F
WILLlAM OTC 1. OR b ,
LOUIS P. PASTA NA.
N/O/F \ OF . . C ONTI �A��D,Sfi
MERL-f ca .1. ME 'A
SAL ROMANO F 0 R
(DWELLING ) {i tl O
Prepared In accordance with the minimum GR '•' LIC NO 49618
standards for title surveys as established
by the L.I.A.L.S. and approved and adopted 1�`' C YORS, P.O
for such use by The New York State Land 1v`
Title Association. AREA = 42,446sq.ft. B®
MA
aEVAT110W Alm AEFEREWM TO ASSUIED DATUM N.sc Rrr.s•o� 9 2/9/ I SOUTHOLD, -X Y. 11927
88 - 165A