HomeMy WebLinkAbout37191-Z gSUF�, � Town of Southold Annex 10/15/2012
o` �a P.O.Box 1179
C
54375 Main Road
co
c • ,� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35995 Date: 10/15/2012
THIS CERTIFIES that the building RESIDENTIAL ADDITION
Location of Property: 500 CARROLL AVENUE SOUTHOLD,
SCTM#: 473889 Sec/Block/Lot: 75.-1-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
1/1/1900 pursuant to which Building Permit No. 37191 dated 5/3/2012
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:
addition, including deck, to an existing one family dwelling as applied for.
The certificate is issued to INEZ&JOHN BEYER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37191 9/18/12
PLUMBERS CERTIFICATION DATED
A ized ignat e
�s�FFu TOWN OF SOUTHOLD
BUILDING DEPARTMENT
N TOWN CLERK'S OFFICE
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 #: 37191 Date: 5/3/2012
Permission is hereby granted to:
INEZ & JOHN BEYER
365 LAKEVIEW AVENUE
ROCKVILLE CENTRE, NY 11570
To: ISSUED FOR ADDITION TO EXISTING ONE FAMILY DWELLING.
REPLACES EXPIRED B.P. # 20120
At premises located at:
500 CARROLL AVENUE SOUTHOLD
SCTM # 473889
Sec/Block/Lot# 75.-1-7
Pursuant to application dated 1/1/1900 and approved by the Building Inspector.
To expire on 1113/2013.
Fees:
PERMIT RENEWAL $50.00
Total: $50.00
Building Inspector
FORM NO. 2
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_ 20120 Z Date .....�...�.
Permission is hereby granted to:
:C :r.. ..�!::.0�!l'.................................
.....U.L�Lz
to ....... ............ ... :1. ................. ..............
. .. ..:.........:.... ....r�:. :.........
=.......
at premises located at ....IWO) ...... ................ .......am.........�.> .......................
....................1 - wl ...q.s`:S !t:!�:1.....[!?x:......................................................................................
County Tax Map No. 1000 Secti 41. ....... Block ..... .�.......... Lot No. ...®. .............
pursuant to application dated .. . .GCaY.r ......�` g........... W.V.-, and approved by the
Building Inspector.
Fee $:4 .......
!� . VLAL
.. ..................... .. ...........
Building Inspector
Rev. 6/30/80
tok
l � � 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 2110 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 $1.5.00;Commercial$15.00
Date. 8
New Construction: Old or Pre-existing Building: ' (check one)
Location of Property: CSC C �xx nn/1n 11� =Gbt�GQ �
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. J%./ Date of Permit. 5 3 —/oP Applicant:
Health:Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate. (check one)
a7�
Fee Submitted: $ Q /Sou
Appli nt Signakure
pF SO!/r�,o
Town Hall Annex l� Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 �Q roger.riche rt(aD-town.southold.ny.us
Southold,NY 11971-0959
COUNTY,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: John Beyrer
Address: 500 Carroll Ave City: Peconic St: NY Zip: 11958
Building Permit#: 37191 Section: 755 Block: 1 Lot: 7
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: as built DBA: License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition X Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 6 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 3 Twist Lock Exit Fixtures TVSS
Other Equipment: 1-paddle fart
Notes:
Inspector Signature: Date: Sept 18 2012
81-Cert Electrical Compliance Form.xls
BUILDING DEFT.
. INSPECTION
[ FOUNDATION 15T [ ] ROUGH PLBG.
[ � FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ) FINAL
REMARKS:
4 - , 1 �4 IJ 7
DATE INSPECTOR
M-isox
BUILDING DEFT.
INSPECTION
[ ] F NDATION 15T [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: �
DATE I � / INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 15T [ ] ROUGH PLBG.
[ � FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
REMARKS: ad�7
ZCd.4
-oz
DATE 4Z/ _INSPECTORS ,.1�
M.1Soz
BUILDING DEFT.
INSPECTION
[ -FOUNDATION 1ST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING ( 7 FINAL
REMARKS:
DATE � � G INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[v FRAMING [ ] FINAL
REMARKS: '- �
-''l.(1"V =/{ ��CvC/! � � /t11./t/` � ,;:tom✓._..2F- .
DATE �/ INSPECTOR
49,4,�
ass-isoz
BUILDING DEPT.
INSPECTION'
[ ] FOUNDATION 1ST [ j�H PLBG.
[ , ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:� 2±2
DATE INSPECTOR ��
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 15T [ ] ROUGH Pl.BG.
( ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING ( INAL
REMARKS: - �.
DATE ozcQ INSPECTOR
e7— V Soll
eou
P`9
TOWN OF SO LD BIJIL G DEPT. °-✓
766-1802
INS Nm ..c
FOUNDATION 1ST R /L ] [ ] OUG tBG.
[ ] FOUNDATION 2ND [ ] 1 LATION
[ ] FRAMING/STRAPPING [ FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL OUCH) [ ] ELECTRICAL (FINAL)
REMARKS.
Az
iDAT INSPECTOR
OF SO�l�olo
� uvv
1 �
TOWN. OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION ..
ti
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ELECTRICAL (FINAL)
REMARKS:
DATE INSPECTOR
/ OF SO(/r�o
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION .
[ ] FOUNDATION 1 ST [ ] ROUGH PLOD. .
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING/STRAPPING [ FI
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
L4
DATE INSPECTOR
LI::LD Ii:S:'E'C'710N DAT OOMMENTS
1 •
( 1st )
FOUNDATION
_
/ c �
FOUNDATION ( 2nd ) C/'
ROUGH FRAME &
-PLUMBING
3 . d4 y
m
I2ISULATION PER N . Y. m
STATE ENERGY
r
CODE p
4 , 3v�
ioAL0 `
FINAL
C.
ADDITIONAL COMMENTS :
&0A
l C
- x
10 _ a ,v'
H i
z I Va
r�- H
Es .i�._ BOARD OF
HEALTH
. . . . . . .
� 0 V L� FORM NO. 1 3 SETS OF L.1VS �
TOWN OF SOUTHOLD SURVEY • • . . . • .
AUG �81991 BUILDING DEPARTMENT CIIECK4t 3n _J_- O,0. . • • . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . .
ILI SOUTHOLD, N.Y. 11971
BLDG. DEFT. TEL.: 765-1802 t:DT I Fy -7
TOWN OF S®UTHOLD (;� CALL .?6-5-3 7 ./.:G�
Examined . 199.�. �� l L ( MAIL TO . Q/r2�wr�- 7G6 -(;/[��. . .
Approved5 ! 19�). Permit No.� . . . . . . . . . . . . . . . . . . .
. . . . . . _ . . . . . . . . . . . . .
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Building Inspector)
Date . . . . . . ., 19 �l
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
lets 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 must be drawn on the diagram which is part of this appli-
-ation.
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 issued a Building Permit to the applicant. Such permit
;hall he 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
;hall 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 for necessary in; o
. . . . . .`. . . : . . . . . . . . . . . . . . . . . . .
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant) j®
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.fit' . � ��•!�(GG�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises . . . � . . . . /.!`f t'�. . . g . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . .
as on the( tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...
(Name and title of corporate
/officer)
Builder's License No. f1 7 ,�,7 ' f�
Plumber's License No. . . . . . . ./. . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No.
1. Location of land on which proposed work will be done. �� .r�C �r•AL'
House Number Street 'Hamlet
County Tax Map No. 1000 Section . . . ./. . . . . . . . . . Block . . . �./. . . . . . . . . . . . Lot . . .
�.7. . .
Subdivision . . . . . . . . . . .. . . . . .(Name) . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . .
'_. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . .
Intended u r`";isn A t«'
b. use and occupancy :UGC . .r:`. . . . . . . . . . . . .
3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . Alteration
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition Other Work
4. Estimated Cost . . C��� ° 13 (Description,)
a �. . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . '. . . . .T
(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 otexisting structures,if any: Front . . . . . . . . Rear :� . . . . . Depth f ' " rB
. . : ' . .`.`.
Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front .Rear
Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . �, . . . . . . . . . . Num er o Stories . . . . .
8. Dimensionsssgf entire new construction: Front / . . . . Rear . . . . . . . . . . Depth .�.,.C2. � .
Height .L/ . . . . . . . . . Number 9f Stories . ...L�l :• _ .
9. Size of lot: Front . 1 .� .7 . . . . . . . Rear . . . . X.
: a s j. . . . De-th T : O .,. . . .�. . . . . . . . .
10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name o ' ormer bOwner . . . ��
1 Zone or use district in which premises are situated .
2. Does proposed construction violate any zoning law, ordinance or regulation: . . .0C).
13. Will lot be regraded . AIQ . Will excess fill be removed r m premises: Yes I N
14. Name of Owner of premises . 7 Address ! .
Name of Architect Jle,)Go, p �; • • Phone No.S': : (-
1 `. . . Address 7.h1us�%J !�d.���Q,( Phone No.
Name of Contractor �aa.��u�i� .�1` l �c��5���ect►a!�ddress �' �, �q
3� .�� 2 . Phone No. . .
15. ls':.this property within 300 feet of a tidal wetland? *Yes, . • . . . . " " '
*If yes, Southold Town Trustees Permit may be required. � �
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions frr.•m
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK, S.S
COUNTY OF . . . . .
• •1 C•"1 e 1• vl. C�r`N`�L�'"�•`�' • • • • • • . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
ibove named.
le is the . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Contractor, agent, corporate officer; etc.)
)f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
!pplication; that all statements contained in this application are true to the best of-his knowledge and belief;and that the
vork will be performed in the manner set forth in the application filed therewith. .
worn to before me this
. . . . . . . . . .day
of. . /. . . . . . . . . . . ., 19 . .
lotary Public, . . . . . . ./y:!: W County
N
1. . . . . . .
JOYCE M.'W1LK1N8 '
Note ryry PublK State of New Yo* . . . . . . . . . . . . . . .. . . . . . . . . . . . . .
No.49b2248,Suf a*Cou (Signature of applicant)
Term ExOtres June 12,1
Iq
a �--� CARD-
TOWN OF :SOUTHOLD ' PROPERTY RECORD CARD
-? /
4
OWNER STREET VILLAGE DIST. SUB. LOT S
FOR -11
MER OW ER E C/ ACR.
�- �61
`�. S W - TYPE OF BUILDING
Ifu
RES. 6 D SEAS. VL FARM COMM CB. MISC. kt. , slue
LAND IMP. TOTAL DATE REMARKS
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable 1
Tillable 2 '
Tillable 3
Woodland
Swampland FRONTAGE ON WATER
Brushland FRONTAGE ON ROAD
House Plot DEPTH o2h`G iPGARC. �� s
Totals �27
o
COLOR
jA
i
TRIM!
M. Bldg. X 3a = Z �� �/ y F�dation Bath Dinette
Extension Basement L 4 Floors O At 1�1• K.
Extension Ext. Walls Zeivo p S/Dias Interior Finish - LR.
Extension Fire Place Heat oftDR.
Type Roof - Rooms 1st Floor BR. 3
Porch Recreation Room Rooms 2nd Floor FIN. B.
Porch Dormer
Breezeway Driveway
Garage ,tj `� .3.� j" 2-S'z-:
Patio -
O. B.
-, Total K,
�f Southold Town Building Department
BPS 54375 Main Road Permit#: 20120
s� �y
x Southold,New York 11971 Permit Date: 9/5/1991
o • o,�� (631)765-1802
Expiration Date: 3/5/1996
-- Parcel ID: 75.4-7
BUILDING PERMIT RENEWAL LETTER
FINAL NOTICE
Dated: 10/26/2011
Applicant: JAMES & INEZ QUINN
Location: 500 CARROLL AVENUE SOUTHOLD
Work Description: RESIDENTIAL ADDITION
ISSUED FOR ADDITION TO EXISTING ONE FAMILY DWELLING
A FEE OF $50.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT.
Owner: JAMES & INEZ QUINN
Address: 365 LAKEVIEW AVENUE
ROCKVILLE CENTRE, NY 11570
The permit listed above has expired. Please contact our office as soon as possible to begin
the renewal process. All work on the project must stop on the expiration date.
21
,yc,0
THANK YOU,
SOUTHOLD TOWN BUILDING DEPT.
Southold Town Building Department
�o�gUfFO(,�CpGy P.O.Box 1179
Permit#: 20120
54375 Main Road
CM
Southold,New York 11971 Permit Date: 9/5/1991
vy�►01 �ao�� (631)765-1802 Expiration Date: 3/5/1996
Parcel ID: 75:1-7
Dated: 4/25/2012
Applicant: JOHN& INEZ BEYER
Location: 500 CARROLL AVENUE SOUTHOLD
Work Description: RESIDENTIAL ADDITION
ISSUED FOR ADDITION TO EXISTING ONE FAMILY DWELLING.
Owner: INEZ&JOHN BEYER
Address: 365 LAKEVIEW AVENUE
ROCKVILLE CENTRE,NY 11570
Your BUILDING PERMIT#20120 has been referred to me because you have not responded to requests
to obtain your Certificate of Occupancy as required by Southold Town code.
Pursuant to 144-15A, of the Southold Town Code, "No building hereafter erected shall be used or
occupied in whole or in part until a certificate of occupancy shall have been issued by the Building
Inspector."
Therefore, you have ten days from the receipt fo this letter to submit a check made out to the Town of
Southold in the amount of$50.00 to renew the building permit, or legal action will be taken against you.
Should you have any questions, call the building department between the hours of 8:00 a.m. and 4:00
p.m.
Respectfully Yours,
aell
Michael Verity: Chief Building Inspector 26bg 9969 2000 0620 OT04
Southold Building Department
cc: Damon Rallis Zoning Inspector
pF SO!/Tyolo
Town Hall,53095 Main Road Fax(631)765-9502
P.O.Box 1179 G • Q Telephone(631)765-1802
Southold,New York 11971-0959
�yCOUNT`I
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
May 25th, 2007
James A. Quinn
365 Lakeview Avenue
Rockville Centre,MY, 11570
RE: 500 Carroll Ave. (Addition)
SCTM#75 17
Dear Mr. Quinn,
Please be advised that your Building Permit#20120 issued September 5th, 1991 has
expired. According to the Code of the Town of Southold, a Certificate of Occupancy
must be issued prior to use of the structure.
To renew your Building Permit,please submit a fee of 50.00; at that time we can
schedule an inspection by one of our Building Inspector's.
If you have any questions,please call us at 631-765-1802.
Respectfully,
SOUTHOLD TOWN BUILDING DEPT.
mfi� o,
PJ
o
2� 00.
0\VI �• oy
G
' a
i
AREA = 2.9020 ACRES -Z2 e� O.c.
O y ti
SURVEY FOR /
INEZ QUINN BEYRER 2�
A T PECONIC
TOWN OF SOUTHOLD W /
SUFFOLK COUNTY, N. Y.
1000 - 75 — 01- 07 nz
SCALE : 1 = 60r 0o b
A UG. 16, 1991
NO
a
�0 LANDftj Sli
Prepared in accordance with the minimum CIO
standards for title surveys as established t3` ' . o
.Y ,L1C. NO. 496/8 by the L.I.A.L.S, and a�proved and adopted \ �n \� py �•��,`P
for such use ,by The :ew York State Land y
(5�6� C. Title Association. 5•
P. O. BOX `� `off
MAIN ROAD _
SOUTHOLD, N.Y. 1197102
91 - 232
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