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HomeMy WebLinkAbout23009-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24003 Date NOVEMBER 2, 1995 THIS CERTIFIES that the building ACCESSORY Location of Property 350 KENNEYS ROAD SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 59 Block 3 Lot 33 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 5, 1995 pursuant to which Building Permit No. 23009—Z dated SEPTEMBER 12, 1995 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 ACCESSORY STORAGE SHED AS APPLIED FOR. The certificate is issued to CORI & KAREN LANG (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A /,Xuifding Inspector Rev. 1/81 FORM NO.3 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) N2 23009 Z Date.................4—hl: ..............., 19.i...... Permission Is hereby granted t Df... .. .............................................. ......�� ..... ............................... ............ ........ ..... .,,,....... .. .�° toxl& .... ...... .................................................................................................................................................................. .................................................................................................................................................................. .�........�.�...... ........................................................... at premises located at.................5- ........................................................... ....... � .Y/.... .................... . ............ County Tax Map No. 1000 Section .......... ... Block..............3....... Lot No. ............................ pursuant to application dated ...................... .. ......... 19...... :...., and approved by the Building Inspector. !ice Fee$.. ...................... /� < Building Inspector Rev. 6/30/80 �1 Form No. 6 1 ) TOWN OF SOUTHOLD j Cori and7Caren Lang BUILDING DEPARTMENT P. O. Box1083 7 6 5N�1 2 Cutc�ogue. ` 11935 �� a l -�; P L5 IUr IJ , APPLICATION FOR CERTI I�ATFTFF0�C� �1NGY� y A. This application must be filled in by typewrite I� nlc�-and,..s'ubmitted to the building inspector with the following: for new bu ldiir. P g� .._ g3t9r 6",n•.ew u;s.e�? k-> 1. Final survey of property with accurate location of-aYr-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: E 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. ^es ' 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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 5f,. Date . . . ./. ..Id-_.7. 9 . . . . . . . . . . . . . . . . . . . . . C " - D Old Or Pre-existing Building . . . . . . . . . . . - New Construction. . . : Location of Property. . . _150 , `. . . . . . . . . . . . . . . . . . . . . . .: . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . . . . . 2�. . . . . , '`,��E A-) . .��iV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . .. . . . . . .Block. . . . .:3 . . . . . . . . .Lot. . . . . . . . . . .I. . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . oaq.� .9%' �9� cog; Z,,u & Permit No. . . . . . . . . .Date Of Permit. . . . . . .Applica.nt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . ...� .. . . . . . . . . . . . . . . . Cam' G� APPLICANT o��g�FFO�,�cO cz cc Town Hall,53095 Main Road p • Fax(516)765-1823 P. 0. Box 1179 y°� �� Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 12, 1995 Mr. Cori Lang P.O. Box 1083 Cutchogue, NY 11935 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is not on file. $25 A0 No Health 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 # 23009-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 1,. • o��s�FFO(�coG y = Town Hall,53095 Main Road p • Fax(516)765-1823 P. 0. Box 1179 �� �� Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 12, 1995 Mr.. Cori Lang P.O. Box 1083 Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health 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 # 23009-Z Please contact our office on this matter. Thank you for cooperation. , SOUTHOLD TOWN BUILDING DEPT. a3 � 5� 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS ATION [ ] FRAMING [ FINAL ] FIREPLACE & CHIMNEY REMARKS: aatLN /Vo DATE � � � INSPECTOR A", PII?'T.D "T.N%-PECTION R(:PORT DATE COMMENTS _________________________ ________11===== ___________________----________-------- _________= W ------------------------ II II -------------- FOUNDATTON ( IST) p II—_—�— —_-- -----___--- ---____.-- II -- II p C FOUNDATION OND) ------------------ ROUGH FRAME 5 II II PLUMBING II II -II ' II II � II H TNSULATTON PER N_ Y. -- STATE ENERGY II CODE H © �Lo.7C�; H FINAT. o � ADDITIONAL COMMENTS: \ H � _ H O \l r b -- ------------------- -- ----------------------------- --------------- y Ud1nu 01 itLaL l 11 . . . . . . . . . 1:0i1M NO. 1 J SETS OF PLANS . . . . . . . . . TOWN 01: SOUTLIOI_L) SURVEY . . . . . . _ . . . . . . . . . . . BUILDING DEPAR-I'MENT CHECK . . . . . . _ . _ . . . . . . . . . TOWN IIALL SEPTIC 1701111 _ . . . . . . . . . . . . SOUTI IOl_D, N.Y. 11971 TEl_.. 7Gli "1f3O2 ttp'f I1'Y ; � _,lb/ Cn1,1, '/ g 1,xaliliIIed . . � . . ., 19 `? . . . . . . . . Q 2 G� limit. 'f0 : Approved lZ ., 19 / f lnit No. .�'.� !. . . . . . . . . . . . . . _ _ . . . . . . . . . . Disapproved arc . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . (Building.lnspeclor) . AI' _ 'ATION FOR BUILDING PEIIMIT Dale . .... ..S. . . . . . . . . . .119z. INS'i,RUC'1'IONS it. 'Phis application must be. coniplelely filled in by typewriter or in ink and submitted to the Building Inspector, wills sets of pl;uls, accmr,ile plot plan to scale. Fee according to scl►edule. h. Plot plan showing lgcation of lot and of buildings on premises, relattonshtp to adjoining premises or public slice, or areas, and giving a detailed description of layout of properly must be drawn on the diagram which is part of this app: cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval o1' this applicattom, the Building inspector will issued a Building Permit to the applicant. Such pernc> shall b.e 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 Occupant shall have been granted by the Building Inspector. APPLiCATiON iS iIERL;BY MADE to the Ilutlding Department for the issuance of a Building Permit pursuant to tic I1Ililding 'Lone Ordinance inace of the 'tn ow of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regillalioms, for the construction of buildings, addilions or alterations, or for removal e`1, demoli(ion, as herein descrihcc- 'I'he applicant agrees to comply wiih all applicable laws, ordinances, building code, housing code, and regulations, and I' mimic aulliorizecl inspecidus on premises and in building for ciecessary inspeclionsi, . . ( _ . . . (Signature of applicant) or name, if a corporation) (Mailing address of applicanl) Stale whelher applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builde OWcvEP C:oJe i A—AR� L,�G Nance of owner of premises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the lax roll or latest deed) II' :cppliconl is a corporation, signature of duly aIllholiz,ed officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Nance and title of corporate officer) Builder's license Ho. . . . . . . . . .�. . . . . . . . . . . . . . . . I'Inmber's License No, . . . f'lech ician's License No. Other 'Trade's license No. . . . . . . . . . . . . . . . . . . . . I . L.ocalion of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . ... �. . . . . . . . . . . . . . . . . . > �Nn1 CYS. .n�. . . . . . . . . . . . . . . . S�fdro l� : . . . . . .. . . . . . . . . . . . . . . (louse Number Street llamlel County 'fax Map No. 1000 Scclion . . . : .Q�9 . . . . . . . . Iilock . .3 . . . . . . . . . . . . . . Lot . .33. . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . filed h4ap No. . , . . . . , . . . . . . . Lot . . . , . . . . . . . . (Name) �. Slate existing Ilse and occup,uicy of premises arld intended use and occupancy of proposed constriction: a. Exislin g Ilse and occic lane SiN�3l� �y. . . .... b. intended use and occupancy . . . . . . . .J.rf !�� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I • I l!kl`'11111 �\lllllluln i111elaliun Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Dcutolilioii . . . . ; . . . . . . . . . . . . . . . . OIdler Mik . <-A RAQr .Yh/ `y (Descl ip(ioll) 4. I'slinlaled Cost . . . .e2e O.0 . : . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. If dwelling, number of cl�velling units . . , . (to he paid on filing lllis application) If nulllher of cars . . . . . . ,� � . . , • , . • . .Number of dwelling un Oil each floor its och. garage, . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing struct . G. If business, conuuercial or nli,xed occupalicy, specify nature and extent of each type of use • , • • • � . • � � � � � • � • • ures, if any: 17ront Ilciglil . . . . . . . . . . hear . . 1)cl�lli . . . . . . . . .. . Number of Stories . . . . . . . . . . . . . . . . . . . . . . Dimensions of shale structure Mill alleraliorls or additions; Front . . . . . . . . . . . . . . . !)elute . . . . . . . . . Height . . . . . . . . . , Rear . . . . . . . . . . . . . . . . . . . . . . . . . : Number of Stories . . . . . . . . . . . . . . . . . . . . . 8. 1)"llensions of entire new conslruclion: 17ront . . . . . . . Ilcighl . . . . . . . . . . . . . . Number of Stories . . . . . . . Rear . . . . . . . . . . . . . . . Ueplh . . . . . . . . . . . 9. Size of lot: Ffo,nt . . . . . . . . . . hear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . lU. Dale of Purchase Depth . . . . . . . . . . . . . . . . . Name of Former Owner • . . . . I I. Zolle or Ilse (hsirlcd Ill which premises are situated . ' , 12. Does proposed conslruclion violate ally zoning law, ordinance or rcgulsiliolI: . • . . . . . . . . . . . . . . . . . . . 13. Will Ic)l be le graded IV© � : . . . ,1 6 0 • • • • • • • • • • • • • • • • • • . . . . . Will excess fill be rcntovcd front premises: Yes I I. Nanle of Owner of premises . . . . . . . . . . . . . . . . . . Add iess Name of )lrchili:cl . . . . . . . . . . . . . . . . . . Phone No... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A(Iclress . I'liolic No. . . . . . . . . . . . . . . . . . . . . . . . Hanle of (:onlraclor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . Phone No. . . . . . . . . l:lta.s properly t�:LCb.1n 300 feet- of a t:fdal. 'wetland? * *If es Southold 'Town Trustees Per.mlt may. be required. No. � P1...0T 1)1ACItAhi Locale clearly and distinctly all buildings, whether existing or proposed, "MI indicate all set back dimensions front properly linos. live street and block number or description according to deed, and show street names and indicate wbelber inferior or corner lot. Sec- sG Rr,t-, r4 kic,t 01 l STATI; 01 Nl::w Y0R1(, ; (::011NT`11 OI . . . . . . . . . . . . . . . . . S.S O R i L s•4>,j C . . . . . . . . . . Name of i i v i. •ua•l . . • • • . . . . . . . . . being duly sworn, deposes and says dial lie is lie applicant ( ndd signing co n lrac O above named. Ile is the . ... . ©wrliC2. . . . . . . . . . . . Wontraclor, agent, corporate officer, Cie..). . . . . . . . . . . . . . . of said owner or owners, and is duly authorized to perform or leave performed lie said work and (o make and file lllis applicalion; (110t all slalelrienls contained in (his application are (rue to. the best of his knowledge and belief; an(I Thal Ibe \Yolk will be performed ill (lie manner set forth in lie application filed therewith. Sworn to before nle this . . . . . . . .(._P. . . . . . . . . . . .clay of . . . . . . . . . . . Notary public, . . . . . r / / . . . . .��/V . : County ,.... : • JaYCE M:lMLIs;IPJS . . . . . . . . . . . . . . . Notary Public,State of New York No. 4952246,Suffolk Counp� ig n a l u r e of applicant) Torm Eypirss..tune 12, 19 "/ OCCUWANCY OR SN �U!3 JFUL DATE: / B.I�# CER-,,,llFlCVi,LA f{ NOTIFY BUILDING �.Ci .� 765-1802 J AM TO 4 FOR TIgF •L F' H' t l!e oo FOLI.�t't,'ING INSPECTIONS: ;;,..r L V. �9I�fD,�,Td c� - T��;%�3 REQUIRED �4'i 2. ROJOI-I - FRAMING. 1 LUIVIBING 3. INS ULATION -- -- 4. FINAL - CONSTRICTION d@ U T SE)COMPLETE FOR C.O. -ALL 6ONSTRUCTION SHALL MEET REQUIREMENTS OF THE N.V. N STATE' CONSTRUCTION -& ENER Cr CODES". NOT RESPONSIBLE FOR IDESI NORCONSTRUC'TIONIERRORS,, O` a e (A� fi a E -h a cn M o x o A -C N � of N Z ch SEP' - 7 IQ9� - UT ------------- r i i ' 1 aou61E boat t`�ND vr.Evy i a'— SE -- 7 1995 £v: Y d j Y i•i \\\ pg 3 W�,,,�\ The The Quaker Gable, A-Frame This is the roomiest shed going. It uses are anything or Cottage from sales office to pool house or even studio — the An excellent addition to our possibilities are endless. y property. Great for storage space and comes in a variety of sizes. Window is included for that extra special look " L i i 6 € II F 11. ;3vs INN i. .�'£ru.�, . The The High Side Barn Dutch Barn High sides and double dutch doors make this shed This Colonial looking barn has enough space for the great for storing light equipment and tools of all sorts. modern day homeowner. The usable space includes room for shelves, a loft,and even a work station. You'll enjoy the look and get the space.1-T� 7 17 WE BUY THE BEST MATERIALS, TO BUILD THE BEST PRODUCTS,TO SELL TO THE BEST PEOPLE-OUR CUSTOMERS . . - . . SUFFOLK GO.. HEALTH DEPT.APPR6V L . ', -, . . 4 H.S. NO. Q'40-94 1,,_S \ 5 `1 . - . .I - . . . — 1,2:�-_­...- ', . . - . ;04- . , . . r i i!�i-�I.t I I�I,.�1I;-,A:f�.-,�...:'I",-;.--..;�I 7,.,..I......'I.i..1..I-..-.%..w-..-..,j-�.I�,_�,-��....n,,.^.....�_.���..�I.1...�--r I7.._!.r­.v��.:I,1:_-%�-.,1..�-'...�...-%....-."�\..,,1`�,.....;::fPf�._-..-.-.--4 F,I�...---S_..I.-.....m/�v..-I-_....._..dd,.'��.-a..�;T-1.-_`�I.U1:."_...-....��,...,.b,�,�.�I bb 4�.,,�.._-.Z-,.-.I.....�­�-.-......;-�...q I�-.�.,I,.:-.I-.�-.- 4. ._ ......'-.,..1-­-,--/.,�I,:. �.1-....._..-..-.,..;�-:-,,�..4-.,...`-.J,':.­I,­,':-.i_.0 1'...�,.1..:I.a,.I..I.-.�,..,­.-..I..,,.,.,.,,.,".....-.._:.--:-.-i.,...,-.--.-...:-...­�-.�1*.�,I.�"I...-W-­-.....-�I...1_,..f.,.I..._.,,..-'�,,:_.i�.'J,.�...,--..--�.._..-,'...'./_.—",:.�4.-1..­,-�,.---..--­.�.....,--�i .'....-�,..:...,w-.,-.i..-,-I''.,-:-I-...-I.....oI.,:',;I-�.��.I1-..-1:"I1.�F.,-'11�..r..,.-�'�..�,,.-.,­.I-,..I I I-"-:.,-.�i�I,.....—.��..�,.�...-�*.;-1—I,_...�­-�.-I"...��,.:,. _I.-��I..I..1�--�..'.,-I\,.'..�..-.::I.., I. 3 - _ ,. 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' T f' O�Sr<U. t�. 14P DES16T#ta cl'. r, a ,:is tf (� /? �j} 4 ls, 1 N CC E �- ,fir"• Rc` /� � 1 T 4. #?$ '. �• r . t' -. - .a - a ..y r $. .1�3, ,ti', ram. 9 `3._ 7. e _ - - , 1 . - fi -.0 d . 7` 1 t 4 ._ _ ..,v' - _. -i . - .. - - _ - - cif _` 5:: y. [7 fr fs88y( P.. ..I._. ?. _ , ' r • , . .. _ j - ..- - . . Section 72116 of the New York State . - - �j(�/({ Education Law ' . # _. 1 s Copies of this survey map not bearing a . - - /������ s, ,i� uw'W the land. surveyors inked seal or.. . - + :- embossed seal shall not be considered Stk'!'l `ft7AM' :, : . r: t' + to be a valid true copy .. TM.1 _ _ - t t. {� - . if' .. 1 _ -k. .�...' ._ Guarantees in h T . _ w-, ;: ,c;' dicated ereen'shall.nm }= f, . and to the n r y perso fo whom the sury - q. .a F eY'. RG fi V.Il -C�• '• _ �._'�''" IS rB 4�54 p pareG,and on his behalf to the' l q C' '3 7 r l A , s< - T ti,la''�: .�;,•; "i" ,. .a >. Y.g�• Com n 'ovemmentala a i. s : w. P�Y•.9 g ncy 9nQ. en In i i i- ,=�= d nst lotion I ste };` s 1 g d hereon and- r' y ;; '� �: o the ossi nees ai the lend n h L; :: r 1 9 g stS -f--' z :f ti J.`� .� lion. uarantees a':� G re not i .�_ (e 1•,:. trans rab e v;i'- EE 4 `C' . x 1^ adddional instdution '_ :x sorsu ue nE _ r �c� �' �,�y ? - r':n j_ J i /�!� t w1 .# - '._' > 3- >,a is '? 'x S i' .n roc. L' H' t r r .,:r.:' , 1 T s i' �y.,� t � . a ` {'. �•- r i• 7. 17J G Q .. .. _ _ - .t..: - ....r�.�.q.� (� _ 1 -L• _C2 �,- r <. F Y- �.'. S M�.r' �- via--.:..:°. .. 4•: .Y,• 1.. y.l L 7 -•t j .t.° - ... ° : - 4 9 k S C r,.-,• ('' h 1 _ -,. �. Sr G K ,r. • . « - P j 4 S e. — '� �P. q'l' O .,,. , ,., O 1<` :'- A. Y" t i f.. V y+ i• u a ?`- �,a..-....-..: 1 r ;. a Y II 1. ✓- i.:: r. r..,,, , r r,+ .1 - /}� r I 5 - 1 -T �i r f. .,. .♦ a.. tom•.. .'`.'.�:'. ;:ti- .. 9 +y�y' A, Lam'',.'- p�'��`; T•". �y ��.� _. f. i,, ^z fI t -w•.rr } h .i r :.r. to ?'T+RVF� E 2 F g y 1 }" �MS 4 P . ,: �' r.; r. +'1r! �, :. :� .., - _r -, ------ >, 4: S p r' y =Y! !` a= } S:i u. �'�A Y 1 :. fsY i L?i �... .t c t •7 ,. - 4. .,�„ .,�,.,.. ,;r .. r•-..- .. - ... T r i r. {( � �r C� Z: , - 1 �l'i�_�! :r•`: . s i�, - :'. r SUFFOLK CO.. HEALTH D"T.APPROVAL H.S. NO. -94-95 . WCq ar AP t ;E. . ffffATEMZMT M 1N T Ole tat )S �► ttt ► ►T� a U�!LY o" evir ►GE DIS �„ SYST430 FflR .'THIS �'RtSIDENCE . *# M Q T" Tiff 5'('rriNDAR�'& OF T�,Mt 8'C3 4 w 'iILN' {KIC CO. DEPT. OF HEALTH 'V4�0 1 - w �t. - _ s X IIMPLIC ANT 07- U ?- .810 Q. "T. - i Yl�t;,. p S#IFFOLK COL4 V. DE!' . of HEAi.f0 SI RV_IVES — FOR AFPJROVAL # tarng'z�la� GRtiCTION ONLY t .. fir•. ' 'I H s. F. rwD, Q o - 9 Q - 95 -DROVED: StFOtiC . T1�►'ft SAP DESIaNlUT4C)N . f� Vie.} �,�,� 8LOCK PCL. $�U2'10 L '3:LiOU .05_q Z S�P qjC U r PfJ,`BC33II$3 GtfTCROCVUE..l.LY,.11935 ? 4%50 O .1—bs84 P. 21 Nto thi� Section 72DB of the New York Stdo } education Astir. r1 Copies of this survey map not bearing -.,,,• - the land surveyors inked I Y i e sea or embossed seat shall not be considered `t to be a valid true Copy. Guarantees indicated her"shall nm s prepared and his only e persone survey �j� y n to the ltG\/_ S{�.T title comp any,governmental agency and Co " !ending institution listed hereon and r - a _ - -- 'o the assignees of the lending nsti- L�h� '' � utbn.Guarantees are not transferable is, , i additional institutions or subsequent AT "AP '� w7era. 4LE 20 �+ ,;,;rtE,,r .-VIA -SANDY St�T LD MOMSCO LOT t:f:4T [ (! 70_ SL: DII Sl. hl MAP: O Ft3{ OL K3 .45r l, 5 4:I+T1CtQLtSS. 1VU4tat T,. E 8QC11J Fy z p�.� t yry i "+r,.t► • i" `SF� S 256 P��