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HomeMy WebLinkAboutZ-46992 lop Town of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 PRE-CERTIFICATE OF OCCUPANCY No: 46992 Date: 04/21/2026 THIS CERTIFIES that the building PRE-CO Location of Property: 275 Munn Ln Orient,NY 11957 Sec/Block/Lot: 17.-3-8 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 03/31/2026 Pursuant to which Building Permit No. 52892 and dated: 04/21/2026 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: Wood framed single family dwelling. Comments: Violations: None The certificate is issued to: Welles J Revoc Trt Of the aforesaid building. Please see attached Housing Inspection Report. t!lhor(jd Signat e Building Department Town of Southold Housing Inspection Report -- - -- - - ---------- ------ Property Info SCTM# 17.-3-8 Property Class: 210 ONE FAMILY RESIDENCE Address: 275 Munn Ln Hamlet: Orient Owners: Welles J RevocTrt Condition of Property: Dated Structure Type of Construction: Wood Number of Stories: 1 1/2 Foundation Construction: Block Numberof Exits: 2 Finished Basement: Cellar: Crawl Space: Garage: under house Breezeway: Deck Type: Porch Type: enclosed porch Patio Type: Mudroom: enclosed entry Building Systems Type of Heater: Furnace FuelType: Gas Hot Water: HWH Electric Panel: Old Air Conditioning: Fireplace: 1 Dwelling Components Rooms/Floor Levels Sub 1 2 3 Additional Items: Kitchen 1 Living Rooms 1 Dining Room 1 Bedrooms 2 2 Bathrooms 1 1 1 Toilet Rooms Utility Rooms Entry Areas 2 Other Accessory Structures: Garage: Construction: Foundation: Barn: Construction: Foundation: Shed: Construction: Foundation: Sleep Quarters: Kitchen Facilities: Plumbing: Swimming Pool: Other: Comments: Full basement Violations: - - - - - - - None Inspected By: Nancy Meyer Inspection Date: 04/16/2026 �aOF so(/T�O # TOWN OF SOUTHOLD BUILDING DEPT. cooMVN�' 631-765-1802 /7 3_p INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [1,�PRE C/O [ ]. RENTAL REMARKS: Ole- �aP— bi-sk a 5,uo c hop h Axs-e v v IL Ln 'SIXl !�;Ao%_de,"e- m . DATE INSPECTOR Authentlsign ID:D78B637B-9C2GF111-9A49-00OD3A4FF82A � B TOWN OF SOUTHOLD—BUILDING DEPARTMENTj',L,; , a I Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 1 7 -09 ,, AR 3 1 2026 I J Telephone(631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny.gov APPLICATION FOR PRE-EXISTING CERTIFICATE OF OCCUPANCY :. w ;em, �:; OWNER(S)OF PROPERTY: Name: I,iUZ Iles ,j I ru I Date: /1)ar(h .30j �CZ(v Physical Address: IT rAoq LaRt 10 V I eKt I N l q 5-� SCTM#1000- I-1 " 3 Phone#: 973 w 7 Email: tqf V{7I1rjV_ Ai in4,1� f'G'✓h Mailing Address: ( ,�d ie ni&YI u ct cl 111117 f(I lit 1�'�" 0 740 th - CONTACT PERSON: Name: b )ich4e I VVeIles _ ,I Mailing Address: go Ed >? of v)?f e a d n� 017 tc la'r N J 0 7d 7 �- Phone#: -". 13 7� y Email: r'Y1bVb J;nk 0 m�. C�Y✓I To apply for a Pre C.O.for an existing building(prior to April 9, 1957)provide the following: • Accurate Survey • Floor Plan • $200 Fee CONSENT TO INSPECTION That the undersigned does hereby give consent to the Building Inspector of the Town of Southold to enter upon the above described property,including any and all buildings located thereon,to conduct such inspections as they may deem necessary with respect to the aforesaid application,including inspections to determine that said premises comply with all of the laws,ordinances,rules and regulations of the Town of Southold. I j entiswvwel Weller 03/31/26 Owner's Signature Date PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) I residing at the above address, do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date DINING AREA 1319"x 13'8" BATH _ 6'3"x 1 5'4" BEDROOM KITCHEN 10'11"x 9'6" 10'3"x 13'2" ENTRY 3'7"x 6'1' HALL 9'3"x 2'11" BEDROOM 13" 0"x117' LIVING ROOM 16'9"x 197' SCREENED PORCH ► 1 3'8"x 7'6" FLOOR PLAN CREATED BY CUBICASAAPP.MEASUREMENTS DEEMED HIGHLY RELIABLE BUT NOT GUARANTEED. HALL 6'2" x 12'9" BATH 5'4" x 916" W.I.C. W.I.C. 812" x 916" 10'3" x 12'9" BEDROOM 13'10" x 19'2" PRIMARY BEDROOM 16'9" x 15'11 " FLOOR PLAN CREATED BY CUBICASAAPP.MEASUREMENTS DEEMED HIGHLY RELIABLE BUT NOT GUARANTEED. r TOWN OF SOUTHOLD PROPERTVI q J. jz, ,A , OWNER STREET VILLAGE DIST. SUB. LOT FORMER OWNER)gWIQ.� U`�Jt� 5�y �N _ E AGR.�/ J. P.lf S._ 1 0","rer " R� ��?5 liS. / �U.y�l'`_'jL,k`r`I;�l j _�G.VrL-,--S i�eII 'S S W ¢ TYPE OFIBUILDING it 15�7 i {';e fi RESCIi fQ SEAS. VL. FARM COMM. CB. MISC. --Mkt. Value -LAND IMP. TOTAL DATE REMARKS �f 1 / {:� ' 1 f ' _ r - '' P`Ars,. 4,-7) 1AJP I l,, j 1 / Vt7 S w L �t"d v 1z6tt S ' tJ AGE BUILDING CONDITION '� —�.>�. "v► `�� r�i .�` ?o I lc a a..i.-r..4-- mle NEW NORMAL BELOW ABOVE kq x)b-�A nq4 r) pit, 0 _ FARM Acre Value Per Value Acre Tillable 1 ------ -, Tillable 2 Tillable 3 Woodland 1 I Swampland FRONTAGE ON WATER /r_° Brushland FRONTAGE ON ROAD r.a . •5 �� . f, House Plot DEPTH ✓ - BULKHEAD Total DOCK NKvf ,t, --�h. __ ■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ MEMO■■■ONE■■■■NO■■■■■■■■■■■ E■OM■UMMEMM■■■ME■■■E INN ONE mMMM■■■■■■■■■■.. ` gIMEN NNHWHEMEMMEMEMMON ME MONIMMMEMOMEMEMOMMIN ONE MEE ■MEMO:-■■■M■■M■M � "' 4 ■ MEN ONE■■■■■■■E■■■■EE■■E ' m�3 'i EE EEEE■MEME■■■E■■MMEM■■■ jrlrlC F S +;•,� . ■E■MM MM,���EMMM�EMEMEM�M t rs `fJ•ui .4J + ' +N,ta.-+.J'' r , d *•�i• S+rFih t r 4.,...'.-. e• J fl,f...7r ff,,stf, r mWLti.it1, r k ar w .•' N 1 k ' pY• k C! E■■■E MENIMMOM ■■M MMEE■M rr f•u',s, vr' ., �E,•�: .., MMMMEN EMOOMEMM EErg■CEME■■■M •• Foundation • • �I�/isiiJi Basement •• 'Ext. Wails interior Finish • _ Place -• �_ •' •• Rooms I st Floori• .4 Rooms 2nd Floor Dormer Driveway i w S 87°12'E N/F NEWELL S 87°12'E N/F MOUNT 64.07' 94.94' N N 9. NO POSS. S 82°52' LU E c N>r co°D 31. M ems' 0 2A� RMeP WALK O 100 a W �' 1p CE O Z I 29.06' N 7-1 yala.s' m I PARCEL III 11.3, ENTRY ,WELL (NIF DEXTER) PIT - 11 STY I w z FR RES w C Z CE {275 z AODI I ClASPH. DRIVEWAY _ 28.91' 32.0 10.0' I Q ENCL to PORCH WOODSTEPS CM NO POSS. FAD w 41 w N 87°12'W 94.U. 94' N/F WELLES C7 PARCELI 0 z 0 a 0 z w 0 8 La ° � I z 7.3w MAs 0.7W CM PILLARS\ CM FD [� :• :.CONC. ': _ •. WALK:" EDGE OF PAVEMENT N 88°06'20"W 95.(Y MAIN ROAD MAP OF DESCRIBED PROPERTY (S.R.25) SITUATE AT ORIENT TOWN OF SOUTHOLD SUFFOLK COUNTY,NEW YORK CERTIFIED TO:XXXX)X XXXXXX XXXXXX ®COPYM13HT2MB WAYMBROMC&ALL RK;HTS RESERVED.DUPLIGTION OFTMS DOLRIM M ISA VM ATION OF FEDERAL MWRIGHTLAW. THIS SURVEY HAS SEEN PREPARED IN ACCORDANCE WITH THECODE OF PRACTICEAOOPTEO BYTHE NEW YORK STATEASSOCIAMON OF PROFESSIOWILLAND SURVEYORS. CERTIFICATION SHALL RUN ONLYTO THE PERSON,THEIR INTERESTANOIORASSIGNS. CERTIFICATIONS ARE NOT TRANSFERABLE F THE EXISTENCE OF RIGHTS OF WAY,ANDIOR EASEMENTS OF RECORD,IF ANY NOT SHOWN ARE NOT GUARANTEED. SCALE 1'=40' ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION rA9.2 OF THE NEW YORK STATE EDUCATION LAW, SCTM 1000-017,00-03.00.008,000 00 NOT SCALE FENCES.OFFSETS SUPERCEDE YES DORMERS,NOSOINL SURVEYED:MARCH 19,2026 LAND SURVEY LONG ISLAND.COM walla erco WARD BROOKS LAND SURVEYOR 11 OCEAN AVENUE BLUE POINT, NY. 11715 (631) 576-7794 (631) 363-3179 50731 �y �FESSION�' WARDBROOKSO@GMAIL.COM FILE#11s94 SHEET 1 OF 2 W TF PARCEL z 1 III PARCEL Z 1 Z C� M MAIN ROAD s ss°06'20"E 100.00' (S.R.25) CM CM FD FD o ¢c + iy b c\r 20 / / i /r U r r a r / WATERS �(TYPICEQ r � L] iir� Q r r /r r / r r / L! co Z N i r ) r '� r MAP OF DESCRIBED PROPERTY SITUATE AT ORIENT TOWN OF SOUTHOLD SUFFOLK COUNTY,NEW YORK CERTIFIED TO:XXXXXX )OCXXXX XXXXXX (qCOPYRI6HT 2M WARD BROOKS.ALL RIGHTS RESERVED.DUPLICATIDN OFTHM DDCUEBiNT6AVIO ATION OF FEDERAL COPYRIGHT LAW. THIS SURVEY HAS BEEN PREPARED IN ACCORDANCE WRH THE CODE OF PRACTICE ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFEMON&LAND SURVEYORS. CERTIFICATION SHALL RUN ONLYTO THE PERSON•THEIR INTERESTANDIORASSIGNS. CERTIFICATIONS ARE NOTTRANSPERABLE. THE EXISTENCE OF RIGHTS OF WAY,AND/OR EASEMENTS OF RECORD.IF ANY NOT SHOWN ARE NOT GUARANTEED. SCALE 1"=200' ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION T209-2 OF THE NEW YORKSTATE EDUCATION LAW. SCTM 10I)MI7.0G-06.013-003.000 00 NOT SCALE FENCES.OFFSETS SUPERCEDF SURVEYED:MARCH 19,2026 LAND SURVEY LONG ISLAND.COM WARD BROOKS LAND SURVEYOR 11 OCEAN AVENUE BLUE POINT, NY. 11715 - Ii (631) 576-7794 (631) 363-3179 50731 J WARDBROOKSO@GMAIL.COM p�°�ESSION��'y FILE#11694 SHEET20F2 1 `or1:State BarAssuciation New York Statutory Short Form Power of Attorney,Eff.of 13121 POWER Or ATTORNEY NEW YORK STATUTORY SHORT FORM (a) CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document. As the "principal,"you give the person whom you choose(your"agent") authority to spend your money and Sell or dispose of your property during your lifetime without telling you. You do not lose your authority to act even though you have given your agent similar authority. When your agent exercises this authority,he or she must act according to any instructions you have provided or,where there are no specific instructions,in your best interest. "Important Information for the Agent" at the end of this document describes your agent's responsibilities. Your agent can act on your behalf only after signing the Power of Attorney before a notary public. You can request information from your agent at any time. Tf you are revoking a prior Power of Attorney,you should Provide written notice of the revocation to your Prior agent(s) and to any third parties who may have acted upon it,including the financial institutions where your accounts are located. You can revoke or terminate your Power of Attorney at any time for any reason as long as you are of sound mind. If you are no longer of sound mind,a court can remove an agent for acting improperly. Your agent cannot make health care decisions for you. You may execute a "Health Care Proxy" to do this. The law governing Powers of Attorney is contained in the New York General Obligations Law, Article S,Title I.S. This law is available at a law library,or online through the New York State Senate or Assembly websites,www.nyscnate.gov or www.nya.%%cmbly.gov. If there is anything about this document that you do not understand,you should ask a lawyer of your own choosing to explain it to you. (b) DESIGNATION OF AGENT(S): I,JAMES F.W +"LLES 275 Munn Lane,Orient,NY 11957 (name of principal) (address of principal) hereby appoint: MICHAEL W1�:MES 86 Edgemont Road,Montclair,NJ 07043 (name of agent) (address o}'agent) as my agcnt(s). New fork Slate Bar Assoeiatinn New York Statutory Shott Form Power of Attorney,Elf.6113t21 If you designate more than one agent above and you do not initial the statement below,they must act together. My agenis may act SEPARATELY. (c) DESIGNA"LION OF SUCCESSOR AGENT(S): (OPTIONI AL) If any agent designated above is unable or unwilling to serve,I appoint as my successor agent(s): ALTSON HOLLAND 85 Lakeview Avenue,Bellingham,llrlA 02019 (name ofsuccessor agent) (address ofsuccessor agent) (name ofsuccessor agent) (address of successor agent) If you do not initial the statement below,successor agents designated above must act together. (_)My successor agents may act SEPARATELY. You may provide for specific succession rules in this section. Insert specific succession provisions}were: (d) This POWER OF ATTORNEY shall not be affected by my subsequent incapacity unless I have stated otherwise below,under"Modifications". (e) This POWER OF ATTORNEY DOES NOT REVOKE any Powers of Attorney previously executed by me unless I have stated otherwise below, under"Modifications." (f) GRANT OF AUTHORITY: "ro grant your agent some or all of the authority below,either (1) Initial the bracket at each authority you grant,or (2) «trite or type the letters for each authority you grant on the blank line at(P),and initial the bracket at(P). If you initial(P),you do not need to initial the other lines. I grant authority to my agent(s)with respect to the following subjects as defined in sections 5-1.502A through.5-1,502N of the New York General Obligations Law: (..1 J (A)real estate transactions; (B)chattel and goods transactions; �a (C)bond, share,and commodity transactions;. (�) (D)banking transactions; (E) business operating transactions; C__) (F)insurance transactions; (_) (G)estate transactions; 2 Nciv York State Bar Association Netiv Yotk Statutory Short Form Power of Attomcy,Lff.6/13121 (H)claims and litigation; (_} (1)Personal and family maintenance:If you grant your agent this authority,it will allow the agent to make gifts that you customarily have made to individuals,including the agent, and charitable organizations.The total amount of all such gifts in any one calendar year cannot exceed five thousand dollars; (J)benefits from governmental programs or civil or military service;. } (K)financial matters related to health care;records,reports,and statements; f y (L)retirement beneCt transactions; (_) (M) tax matters; ( ) (lei)all other matters; (i) (0)full and unqualified authority to my agent(s)to delegate any or all of the foregoing powers to any person or persons whom my agent(s)select; ( ) (P)EACH of the matters identified by the following letters A,B,C D EX G j1,Ij K T N1 1,N,0. You need not initial the other lines if you initial line(P). (g) CERTAIN GIFT TRANSACTIONS: (OPTIONAL) In order to authorize your agent to make gifts in excess of an annual total of$5,000 for all gifts described in(1)of the grant of authority section of this document(under personal and family maintenance), and/or to make changes to interest in your property,.you mtist expressly grant that authorization in the Modification:section below- If you wish to authorize your ngent to make gifts to himself or herself,you must expressly grant such authorization in the Modifications section below. Granting such authority to your agent gives your agent the authority to take actions which could significantly reduce your property and/or change how your property is distributed at your detith. Your choice to grant such authority should be discussed with a lawyer. I grant my agent authority to make gifts in accordance with the terms and conditions of the Modifications that supplement this Statutory Power of Attorney. (h) MODI.I`IC:ATIONS: (OPTIONAL) In this section,you may make additional provisions,including,but not limited to,language to limit or supplement authority granted to your agent,language to grant your agent the specific authority to make gifts to himself of herself,and/or language to grant your agent the specific authority to make other gift transactions and/or changes to interests in your property. Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf_ In this section,you may make additional provisiossn% if you ALSO wish your agent(s)to be compensated from your assets for services rendercd.on your behalf, ztnel yoci nary define "reasonable compensaticyn_°t l giant the following authority to my agents as specified in numbered items 1,2, 3,A, 5,6,7, 8,9, 10, 11. 12, 13 and 14 below: 1_ Authority To Make Gifts: I authorize my attomey(s)-:n-fact to make gifts on my behalf of any amount(outright or in trust) including gifts of real and/or personal property that I may own to my spouse and/or lineal descendants and their spouses for the purpose of Medicaid eligibility.now or in the future 3 NeW York Stale Bar Anndition iIN=fork Stahrtory short Form Power ofAtrnrnuy.Eff_fif]3121 and/or estate planning and/or any prudent purpose. 2. 1 grant specific authority for the following agent(s)to make gifts to himself or herself for the purpose of Medicaid eligibility now or in the future and/or estate planning and/or any prudent purpose: 'IYUCHAEL WELL S,as agent and ALISON HOLLAND,as.successor agent. 3. Authority to Create,Revoke,Modify and Fund Trusts: I authorize my attorneys)-in-fact to create, revoke,fund with my assets and/or income and modify existing trusts on tray behalf,including,but not limited to,Grantor Retained Annuity Trust,an Irrevocable Trust and/or Revocable Trust and/or act as Trustee. 4. Authority to Engage in.Estate and/or Medicaid Planning: I authorise my attorneys)-in-fact to engage in estate and/or Medicaid planning on my behalf,including,but not limited to;making gifts,whether outright or in trust,of any or all of my cash,real or personal property or interests in property,including any right to receive income from any source;and to make gifts to individual: and/or organizations,whether charitable or otherwise,and/or to satisfy pledges I previously made; and to purchase and/or enter into an annuity contract with third parties,that is in compliance with the Deficit Reduction Act of 2005;and to use any ether devices I would use if I had capacity,for the purpose of providing for my spouse and/or other members of my fancily or their spouses,and/or reduce tax liability and preserve assets for use by my spouse or other family members in the event l require long term health care. S. Authority to Continue Making C;if s/Split Gifts: In.addition.to the gift giving authority granted to my attorneys)-in-fact granted herein,I authorize my attorneys)-in-fact to continue making gifts of my property to carry out my lifetime giving patterns,or to begun such a pattern if deemed prudent. Furthermore,I authorize my attorneys)-in-fact to elect,in his or her discretion,a"split gift'with my spouse,if I am married,pursuant to section 2513 of the Internal Revenue Code,its successors,or its state; law equivalent. I hereby give my consent to any such election and authorize my agent to sign,on my behalf,an affidavit or other proof necessary to effectuate such election; Authority To Make Statutory Elections: I authorize my attorneys)-in fact to execute all statutory elections and disclaimers of whatsoever kind or nature,including,but not limited to,qualified disclaimers to effect tax savings,disclaimers to defeat the interests of any and all creditors,and disclaimers to pass properties to successor;; G. Authority to Purchase Life Insurance: I authorize my attorneys)-in-fact to purchase and/or amend life insurance policy(ies)including,but not limited to changing beneficiary(ies)or ownership thereof,- 7 Authority As To Debts: I authorize my attorney(s)3in-fact to forgive and collect debts; S. Authority As To Insurance: I authorize my attorney(s)4n-fact to deal with any and all insurance policies I may own or may be qualified to purchase,including but not limited to the following types: life, medical,disability,long term health care for home care and/or nursing home care,homeowners and vehicle. Such power shall include but shall not be limited to the purchase and/or cancellation of any such policy or the liquidation of such policy;and the change of ownership or beneficiary designations of any such policy; 9. Authority As to Safe Deposit Box(s): 1 authorize my attorneys)-ift-fact to remove the contents of 4 IIH ;New York StateBar Association New York Stahnory Short Form Power ofAttorncy.Efr 6113la':i any and all safety deposit boxes in my name,and distribute the contents thereof to my spouse and/or lineal descendants and their spouses,and/or to beneficiaries set forth in my Last Will and Testament; 10. Any gift of my property may be transferred in cash or in kind,and may pass outright to the recipient or may be transferred to a custodian under the Uniform Transfer To IMinors Act.which may be established by my agent(s); 11. Best Interest: In making gifts of my property,my "best interest"shall include gifts which would he likely to cause a reduction in estate or gift tax due or which would carry out a plan for the protection of my assets against the costs of potential future nursing home care and other future health care needs; 12. Authority to Purchase an Annuity: I authorize my attorneys)-in fact to purchase and/or enter into an annuity contract with third parties,including my attorneys)-in-fact; 13. Authority For Banking Transactions: I authorize my attorneys)-in-fact to establish,withdraw funds from,liquidate and/or transfer any and all.stocks,bonds and/or accounts with any financial institution including but not limited to batiks,brokerage firms and/or insurance companies; and to name and/or change any owner and/or co-owner,and/or beneficiary and/or any Transfer on Death beneficiary designation to or for the benefit of my spouse,and any of my lineal decedents and/or their spouses; 14_ Authority As To Retirement Benefits: I authorize my attorneys)-in fact to make all necessary decisions and elections,of whatsoever kind and nature,regarding my Social Security benefits and any annuity,pension or other retirement plan(s)or funds,or..similar type of plans,that I may possess,including, but limited to,lump-suin payouts,installment payouts,roll-overs,contributions,changes of ownership, beneficiary designations or waiving non-employee spousal rights. (i) DESIG1YSUON OF IMONITOR(S): (OPTIONAL) If you unsh to appoint monitor(s), initial and fill in the section below: ( �l I wish to designate , whose addresses}is(are) ' as monitor(s). Upon the request of the monitor(s),my agen(s)must provide the monitors) vith a copy of the power of attorney and a record of all transactions done or made on my behalf. Third parties holding records of such transactions shall,provide the records to the monitor(s)upon request. Ci) CONTENSATION OF AG ENT(S): Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf. If you ALSO wish your agent(s)to be compensated from;your assets for services rendered on your behalf,antler you vviah to cle;fiuc"icasonable compensation",you muy Flo so above,under"Modificatiotts"- (k) ACCEPTANCE BY THIRD PARTIES., I agree to indemnify the third party for any claims that may arise against the third party because of reliance on this Power of Attorney. I understand that any termination of this Power of Attomcy, whether the result of my revocation of the Power of Attorney or otherwise,is not effective as to a third party until the third party has actual notice or knowledge of the termination. 5 New York State Bar Assoeiation New York Statatary short FORM POW of Attomey,Fff.6113121 (i) TERMINATION: This Power of Attorney continues until l revoke it or it is terminated by my death or other event described in section 5-1511 of the General Obligations Law. Section -1511 of the General Obligations Law describes the manner in which you may revoke your Power of Attorney,and the events which terminate the Power of,Attorney. (m) SIGNATURE AND ACKNOWL-EDGMENT: In Witness Whereof j have hereunto si e(d my rine o ply C? ,2024 PRINCIPAL signs here: PILME-A F.WELL 8 STATE OF NEW YORK ) Sy- COUNTY OF SUFFOLK) On the � day of July 2024,before me,the undersigned,personally appeared, .TAMES F.WELLES,personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in.hislber capacity,and that by his/her signature on the instrument,the individual,or the person upon behalf of which the individual acted,executed the instrument. ERnc.bsEPH MCMRM Kch wy Fubllc,Stabs of Naw York N0.02MS625 IS QMllW to Suftk County Notary Public CturlmWjon Expires Mrwy B, g (n) SIGNATURE OF WITNESSES: By signing as a witness,I acknowledge that the principal signed the Power of Attorney in my presence and in the presence of the other witness,or that the.principal acknowledged to me that the principal's signature was affixed by him or her or at his or her direction_ I also acknowledge that the principal has stated that this Potiver of Attorney reflects his or her wishes and that he or she has signed it voluntarily. 1 a not named herein as an agent or as a permissible recipient of gifts. Sig ruure of Witness 1 .4ignatura©j*Witness 2 a _ 2024 July._S 2024 t3:(,`C. �{'�(l�cT i„t:�i•anSr� C�iK .1%1 CA(F-MCI A 13235 Main Road 1.3235 Main Road Mattituck,NY 11952 Mattituck,ICY 11952 _ 6 �1■�I 7 York State liar Association New York Statutory Short Form PoweroFAttomcy.Eff.6113r21 {r,} iMPORTANT INFORMATION FOR`i' F' AGENT: When you accept the authority granted under this Power of Attorney, a special legal relationship is created between you and the principal. This relationship imposes on you legal responsibilities that continue until you resign or the.Power of Attorney is terminated or revoked. You must: (1)act according to any instructions from the principal, or,where there are no instructions, in the principal's best interest; (2)avoid conflicts that would.impair your ability to act in the principal's best interest; (3)keep the principal's property separate and distinct tom any assets you own or control, unless othenwise permitted by law; (4)keep a record of all transactions conducted for the principal or keep all receipts of payments and transactions conducted for the principal; and (5)disclose your identity as an agent whenever you act for the principal by writing or printing the principal's name and signing your own name as "agent" in either of the following manners: (Principal's Dame) by (Your Signature)as Agent,or(your signature)as Agent for(Principal's Name). You may not use the principal's assets to benefit yourself or anyone else or make gifts to yourself or anyone else unless the principal has specifically granted you that authority in the modifications section of this document or a Non Statutory Power of Attorney. Il.'you have that authority,you must act according to any instructions of tite principal or,where there are no such instructions, in the principal's best interest. You may resign by giving written notice to the principal and to any co-agent,successor agent,monitor i r one has been named in this document,or the principal's guardian if one has been appointed. If there is anything about this document or your responsibilities that you do not understand,you should seek legal advice. y;meaning of the authority given to you is defined in New York's General Liability of agent: Th Obligations Law,Article 5,Title IS. If it is found that you have violated the law or acted outside the authority granted to you in the Power of Attorney,you naay be liable under the law for your violation. (p) AGEiNFT'S SIGNATURE AND ACKNOWLEDGMENT OF IPOINTAWNT: It is not required that the principal and the agent(s)sign at the same time,nor that multiple agents sign at the same time. Uwe, 1VIl(11AE1,WELLES have read the foregoing Power of Attorney. I am/we are the person(s) identified therein as agent(s)for the principal named therein. I/ wee acknowledge miylour legal responsibilities. In Witness Whereof hay=e hereunto signed my name on 2024 Agent(s) sign(s)here: => �'?r ✓Y .. MICH�1 !J,VELLES 7 11111! —j`-+ New York State Bar A-ssadatlon Ncw Yurk SLdutory Short farm Power of Attamo}•,Etl:611317.1 STATE OF NEW YORK ) SS. COUNTY OF SUFFOLK ) On the day 73Ut 1 20M before me,the undersigned,personally appeared M CHAE L NVl�',T.JXS,personally known to me or proved to nee can the basis ol'salisl'actory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity,and that.by his/her signature on the instrument,the individual,or the person upon behalf of which the individual acted, executed the instrument. EMKJOSEPH MCMENM Notary Public,State.of NewYork No.02MS6255319 WNW In Suffblk oomntM1on l i=sb:County 4L 2r>��* ed y Public (q)SUCCESSOR AGENT'S SIGNXMIZE AND ACKNOWLEDGMENT OF APPOIN TM NT: It is not required that the principal and the SUCCESSOR.agent(s),if any,sign at the same time,nor that multiple SUCCESSOR agents sign at the same time. Furthennore,successor agents can not use this power of attorney unless the agent(s)designated above is/are unable or unwilling to serve. I/we,ALISUN H0TLAND_,have read the foregoing Power of Attorney. I am/we are the person(s)identified therein as SUCCESSOR agent(s)for the principal named therein. in Witness Whereo:rI have hereunto signed my name on_ 20_ Successor Agent(s)sign(s)here: —> ALIS()N HOLLAND S`l'A: E OF NEW YOR K ). ss: COUNTY OF SUFFOLK ) On the day of ,20_,before me,the undersigned,personally appeared ALTSON HOLLAND,personally known to me Ur proved to me on the b9sis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity,and that by his/her signature on the instrument,the individual, or the person upon behalf of which the individual acted,executed the instrument. Notary Public 8 i "r�"!--Ne►u York State.Bar.Association New York Statutory Short Form Pourer of Attorney,t ff.&13121 STATE OF NEW YORK ), ss: COUNTY OF SUFFOLK ) On the day of ,20 _, before me,the undersigned,personally appeared personally kno-v&m to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknoNvledged to me that he/she executed the same hi his/her capacity,and that by his/her signature on the instrLunetnt,the individual,or the person. upon behalf of which the individual acted,executed the instrument. Notary Public 9 VfFOLk Town Hall Annex Town of Southold 54375 Main Road a ` ' PO Box 1179 Pre CO Inspection Survey Southold, NY 11971-1179 Tel: 631-765-1802 ._._Property Info SCTM # Date Add Hamlet ejZlexfs "Property Type Occupied Prior Permits Inspector �— Structure B Type of Construction: p Number of Stories: Z lFoundation Type_ Ojdl��� jExterior Access: .... ;Full Basement Crawl Space: Finished: +Garage Breezeway Entry Porch: a -Ci{o 4 �IExterior Deck: S9/Q J e,-hjl'3 o Pati -a 0. Y . Mudroom .tf dS - Building Systems HeatSource: '�lJl�-Y�,�(� .. .�..�M� !FuelTYpe�..��s..<.�JF�� . i"Hot Water: �,�J !Electric Panel: p 1AC Fireplaceim Condition of Property Building Interior: �Q Building Exterior. � ¢ _- - - k Property clean, maintained & safe: Fencing: � -- . .... .. Interior Components a Rooms/ Floor Levels Sub 1 2 —3 Safety Items: Kitchen 'Number of Exits: Living Rooms I i Smoke Detectors: Bedrooms �Y� 1 Carbon Monoxide: ...___-.- _._--.-_-_ ... -_.. .__._.__..._ Bathrooms ` ( � Guards & Handrails: Toilet Rooms Egress within Bedrooms: 'Utility Rooms Rooms Fire Extinguishers Entry Areas 1 OTHER LDi Accessory Structures: ' >fGarage~..,�.,�..._.......,�,_,.-A..4.�..._..,� Construction:,.�.4.,.�, Foundation:_...,,�.,._.,...._...._..�....v=r,.' __._..._.._.. — _ .__............... . _...,. ..._ . .._.. ... ... t; Barn: Construction: Foundation: _.. . ......_....._...._........_...--_._......-..............- - ------........._....... _._... .--............:....... ...._._ .. .._..... ... .._. .....! n Shed: Construction: Foundation_ k Sleep Quarters: Kitchen Facilities: Plumbing: ----._-__ ..... ............ _.. Swimming Pool: Comments: . . k i! 4 N'.._..._ ...__. .. _ _... .__..._. . ..._...._ ._ _. . K violations: n ..._. .._ ._.__.__._ _....__._......._._..._._...__--._.._._,....__....._..._........_ r, .._. ._. ._ .._.......___._.__.-.__.-__._.___._ .. _�—.__.._.._.r____._.. _._... ._.._... _ _ . .. ........_.-._ . ......._._._.__.....___...__._...__....._.-.._.......... ................_.. ._._ ...._..t k' a I _