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HomeMy WebLinkAbout44833-Z 1 �o�p FF01 Cpp� Town of Southold 7/18/2020 0 P.O.Box 1179 4' 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 4-1269 Date: 7/18/2020 THIS CERTIFIES that the building GENERATOR Location of Property: 190 Pheasant Pl, Greenport SCTM#: 473889 Sec/Block/L'ot: 53.4-44.36 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/16/2020 pursuant to which Building Permit No. 44833 dated 6/4/2020 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 generator as applied for. The certificate is issued to Greenport W Holdings Inc i of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44833 7/13/2020 PLUMBERS CERTIFICATION DATED Authorize 1- ature o�SEF l'��oTOWN OF SOUTHOLD ay BUILDING DEPARTMENT g TOWN CLERK'S OFFICE "off • ops 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#: 44833 Date: 6/4/2020 Permission is hereby granted to: Bogardus, William PO BOX 244 Morristown, NY 13664 To: install an accessory generator as applied for. At premises located at: 190 Pheasant PI, Greenport SCTM #473889 Sec/Block/Lot# 53.-4-44.36 Pursuant to application dated 3/16/2020 and approved by the Building Inspector. To expire on 12/4/2021. Fees: ACCESSORY $100.00 CO-ACCESSORY BUILDING $50.00 ELECTRIC $85.00 $235.00 Buildi4g Inspe Form No.6 TOWN OF SOUT14OLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing"land uses: 1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00, Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy- $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00` Date. 3 �p New Construction: Old or Pre-existing Building: (check one) Location ofPropert_ . ' OcIQ PNj_71tSnNT ,pLflCp , Ci�,l=�t��o�.c � t slq�N House No. Street Hamlet Owner or Owners of Propert}� Qpp� T pRG fc0 .1 Suffolk County Tax Map No 1000, Section Block Lot *4. 9% Subdivision Filed Map. Lot: Permit No. ✓3 Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ SO - A icant Sig ature BtflIdiniz Department Application AUTHORIZATION 5 (Where the Applicant is not the Owner) 2 I, 0 2Z I residing at )q® eQ (Printproperty owner' ame) (Mailing Address) do hereby authorize (- (Ag to apply on my behalf to the Southold:Building_Department. 3 Z.C12C� (Owner's Signature) ( ate) �Z2 (Print-Owner ame) So Town Hall Annex ® Telephone(631)765-1802 3K 54375 Main Road <`r :_ ' ` Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 sean.devlin(a�town.southold.ny.us �° �_�t,r; � �® COU BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To Greenport W Holdings Inc Address: 190 Pheasant Place city,Greenport st: NY zip: 11944 Building Permit#: 44833 Section 53 Block: 4 Lot. 44.36 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: CELI Electrical License No: 1022ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Ganerator X INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceding Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment. 22kW Generac Generator, 150A Whole House Transfer Switch, 100A Breaker on Generator Notes* Generator Inspector Signature: Date: July 13, 2020 S.Devlin-Cert Electrical Compliance Form.xls OF SOUlyOlo H NojEAs*j-r��{ PtTOWN OF SOUTHOLD BUILG, DEPT. �ccourm,N�` 765.1802 INSPECTION [ ] -FOUNDATION 1ST [ ] ROUGH PLBG.- [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY j ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION �1 ] PRE C/O REMARKS: DATE ANSPECTOR FIELD INSPECTION REPORT I DATE COMMENTS FOUNDATION(IST) ------------------------------------- FOUNDATION (2ND) m z • 0 ROUGH FRAMING& A-ZH PLUMBING ell- INSULATION INSULATION PER N.Y. H STATE ENERGY CODE FINAL ADDITIONAL COMMENTS o . � z rn a� o ® z x • y C t�1 WO H TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 Ulan RO ra— 1_� L FAX: (631) 765-9502 f 19,3371 Survey Southoldtownny.gov PERMIT NO. -� Check —ZFwAees C.O.Application �rt Examincd '20 Singie&S ,pekfate, l SMTM- _ 16 202® Contact: Appioved ,20 ' Q` Mail to: Disapproved a/c _ t Phone.�� xpiration ,20 Building Insp for APPLICATION FOR BUILDING PERMIT Date" `J O D , 2010 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shali be kept on the premises available for inspection tlirougiiout the wo k. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or Regulations,for the construction of buildings, additions, or alterations or for remoy4l or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances,building code, sing code, and r ulations, and toad it authorized inspectors on premises and in building for necessary inspections. (Signatur of app ican r name, f a c rporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ---4 F-1 C-C-,T k C-o 4 _ Name of owner of prem,S�ROPE �A£tffOg,2-1 (As on the tax roll or latest deed) If appheant 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. 1. Location of land on which proposed work will be done: �1 i�� P�,�A-<C H�s�' �t_iar✓1= ����x���, �� i ll of��-i _ House Number Street Hamlet ,t{ �• \�..�I•i tri •.remit- 1{ if.J County Tax Map No. 1000 Section ,'..r i Bl'ock�{ a � Lot {i•,,: i M Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Ad ' 'on Alteration Repair Removal Demolition Other Wor Cj Mn �� (Despription) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars W l 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear_ Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear . Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO i 3. Will lot be re-graded-I YES NO Will excess fill be removed from premises? YES NO 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Naive of Contractor Address Phone No. :15:a. this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF ) 0m C1,0glq ChiA being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the WKCV_INGC�n,0U (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to snake and file this application; that all statements contained in this application are true to the best of his ledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swor to before me this < < � day of 2 ?C� NUR A PEN ",.�OTARY PLISLIC-S W YO Notary Public No.01 PE6261635 Si ature of Appl' a t Qualified In Suffolk County My Commission Expires 05-14-2020 TdwiHallAMM �'elep6nae(63�)76�-180 54875 i1w=Read roger. ohe o safe o 6.nyus. �,0„�c 1179 soutd,MY 119714M H ri MDMDEPARTMENT . TOWN OFSOUM)LD APPLICATION. FOR ELECT&1QA_L INSPECTION . REQUESTED 13Y. C�R�C�� ate: $to lmb Company Name: a tc, �T license No,: address: t Uf r Phone-No-.: 6 •ur- .-u'1 ,fOSSITE INFORMATION.9 (*jndiqates.required information) "tVame: DbE0.s p� C41f0%Z% *Address: - ICO PNEA S A L fit.AC'E i,,[;R E P_N PQ1T MY. 11 A 14W *Cross Street: ��Q 1nilN 1�LU� *Phone No.: GIN,In• R11"1 penrlt X10:: Tax Map QWdet: 1000 Section:-.6b -- - ock: Q _ Lot QLI. big *BPJEF DESCRIPTION OF WORK(Please PrInt Cieairiy) {Please role AIR That Apply). '*Isjob ready forinspedon: 01NO Rough In- nal. *Ob you need-a Temp CertlfiWe: Tetnpinformaflon(If needed) ' *SeNICe Size:' i Phase. 3Phase 100 150 . 200 30Q. - 350, 400 Other *New Servioe: Re-connect Underground Number of Meters Change of Service overhead Additional Information: PAYMENT DUE WITH'APPLICATION - � £6ZZ98Z - lb�6l'Ol-SL-LL a c ' BARGAD,T AND SALE DEED WITH(COVENTA-NT AGARii'ST G IR _ 'MR'S i TAiDA—I FYBTi U FORM 8007 CAUTION I'N15 AGREEMENT (�SHOULD BE PREPARED B1'AN ATTORNEY AND REViFWF.D BY ATTORNEYS FOR„EANDLLER AND Gr PURCH4SERBEFORESIGNING ?'a S ala DEN JP'—P,made the 7 day of January 2020 bo c V between 10W S.FALIJ3-Mri-BOGAlt DDS.,as saa;rviving rjoiot tenar1.with right of survivorshit of WILLIAM E.BOGARDUS,who riled a resident of Sd.Lawrence on 11/24/2018 pursuant to S' Lawrence County Surragates No.2019-53308,residing at 303 Gouverneur Street,Morristown,t1'1366 party of the first part,and - GRL4Nj-13};T'W.FTOLJOIENGS 11'4C. having its principal place of business at 44 Country Club Drive,Fort Wzshingioa,N " 11050 party of the second part, 9"InIF,89ST74 that the party of the first part,in consideration of Ten Doilars and other 1,�4ul consideration,tawfiri money of the United States,paid by the party of the second part,does hereby,,;ant and release unto the party of the second part,the heirs or successors and assigns of the party of the Seco-nd pari forever, ALL that certain plot,piece or pai cel of land,with the buildings and improvements thereof:erected, situate,lying and being at Greenport,Town of Southold,County of Suffolk and State of New York SEE SCHEDULE'A'ATTACHED HERETO AND MADE A PART HEREOF Being and intended to be the same premises conveyed to the party of the first part by deed in Liber "2022 page 701. 1'OGETHEM with all right,title and interest,if any,of the party of the Crst pari in and to any str eis.fn'hoads abutting the above described premises to the center lines thereof T C G—FIWER with the appurtenances and all the estate and rights of the patty of the first pa`:in and to said premises, TO FL4V AA1 ry'TO RYOLD the premises herein granted unto the party of the second part,t.-i:heirs or successors and assigns of the pity of the second part forever, 4ND the party o;the first part,covenants that the party of the first part has not done or sufff,-ed anything , whereby the said prenih&s have been encurnbered in any way�vfiatever,except as aforesaid AND the parry of the fii st part,in compliance with Section 13 of the Lien Law,covenants thri.the party of the first part will receive the considef ation for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improveinent and will apply the same first to the payment of the cost of the improvement befoic using any part of the total rdthe sane for any othef purpose. The word"party"shall be const]Lied as if it react"patios"whenever the sense of this mdentu-f�so requires IN f'✓I Ii/E S3'rf.FI RL'0E,the pally of the fii st part has duly executed this deed the day anc year first above written 12 r"'E4"' NYSBA Resfden4a!Real Estate Fo zn:on I IotUocs (9/Ii0) Copyr]aht Capsoft''DI-Welopment - -1- AbiiT rusl Title hiSiirajiee Co;?zpaiitl Title Number NETS-1L,-03-19 Page•I SCHEDULE A DESCRIPTION ALL that certain plot, piece or parcel of land, situate, lying and being at Arshamoaque, in the Town of Southold, County of Suffolk and State of New York, known and des t,nated as and by Lot No 34 as shown on a certain map entitled, "Map of August Acres, action 1" and ,filed in the Office of the Clerk of the County of Suffolk on June 3, 1991, as Map No 9107,bounded and described as follows BEGINNING at a point on the Southeasterly side of Pheasant Place, a tie dis,ance of 165 00 feet Southwesterly from the extreme Westerly end of an arc of the cul-e which connects the Southwesterly side of August Lane with the Southeasterly side of ?heasant Place, RUNNING THENCE South 31 degrees 32 minutes 30 seconds East,335 76 feet, THENCE South,60 degrees 00 minutes 00 seconds West, 100 00 feet, THENCE North 43 degrees 09 minutes 40 seconds West, 306 11 feet to the Southeasterly side of Pheasant Place, THENCE along the Southeasterly part of Pheasant Place North 46 degrees 50 minutes 20 seconds East, 165.00 feet to the point or place of BEGINNING FOR INFORMATION'ONLY: Said premises being more commonly known-and de,oignated by the street address 190 Pheasant Place, Greenport, New York: tax map de.gnation District 1000 Section 053.00 Block 04 00 Lot 044 036 . 1 STATE OF NEW YORK ) - COUNTY OF On the `7 day of in the year 2029 before me,the undersigned personally apr.,aced>'Es;ain S. Merme-Bogardus,pdsonalIv known to me or proved to me on the basis of satisfactory evidence t be the individual whose name is subscribed to the within instrument and acknowledged to me that she exe: ted the same in her capacity,that by her signature ori Clio instiurnent,the individual,or the pet son upon behalf of s-htch the individual acted,executed the instrument. NOTARY PUBLIC — Carol lk.Peacock Wotar{No.lIC'oiPEStale 6i63593 uYorK oualfied to St.Lawrenc Ct?u Cornmtsston Expires '€ DEF-D itjfe IIs. -7" '3Sectior I,h53.Q1® Moelk 04.00 PALEHRA/R'01-i3-GAaDD JS Lot 014.036 County or Town SIJFF FOLK To INC. Iel,nrn By IMtail To: J2ck Grossrrt-,m,Esq. 163-09 NorrthernMyd. Flushing.NY 1358 Reserve T hris Spstee For Use nl Recording Office NYSBA Rcsidenttal heal F,statc Fomis on Ho(Docs"(9/00) Copyrtgh(Capsoft"vet elopment NEW Department of Taxation and Finance TP-584(9/19) Recording office ame stamp 0!W Cornbinad ReFE'L' EState Transfer—tax Rratu.rn, "Ele M,01,1',gage L-'eklffica�M, and CS511fiCaMorb of Exairnp2ion from the Payment of EsUrnaiteci PersonM income Tax I See Form TP-584-1, Instructions for Form TP-584,before completing this form Print or type Schedule A-G'niormaimF"___Iaririg to conveyance Grantorn ransteror I Name(if individual,IaM,first,middle in-tiail to mar;en xi;more than one gianton Soctui-.Security numb SS? Z Individual Palermo-Bogardus,Kim S ❑Corporation Meting address I a El Partnership 303 Gouverneur Street El Estate/Trust City State ZIP code Employ or Identification Number(EIN) E3 Single member LLC Mornstown NY 13664 ❑Mufti-member LLC Single member's name if grantor is a single member LLC(ser insirucirtors) Singfc member EIN or SSN ❑Other I _ra_ntee/Tr9FsfjFe_j_ a-me-photi-widual,last,-first,�middle in,bal-,1 1 0 ifftriark anX 7ifmore than one�vmnte,) ❑Individual Greenport W.Holdings Inc 7-6 6 V2_ V-4 Feel Corporation tviailing address SSN f-I Partnership 44 Country Club Drive CF I/-3 Y7 Y,2 13 F7 Estate/Trust City State KIP code EIN o Single member LLC Port Washington NY 11050 F-1 Multi-member LLC Single member's name igraritee is a single rrember LLC(see instnichons) Singig member EIN or SSN o Other Location and description of property conveyed Tax map designation- SWIS code i Street address City,town,or village County Section,block&lot (six digits) (include dots and dashes) 053.00-04.00-044 036 190 Pheasant Place Greenport Suffolk Type of property conveyed(mark an X in applicable box) I One-to three-family house 6 ElApartment budding Date of conveyance Percentage ref real property 2 ❑Residential cooperative 7 El Office buildingconveyed j,;i:ch is residential 3 ❑Residential condominium 8 El Four-family dwelling [—T I I real prope',v 100% 4 El Vacant land 9 0 Other M-0, day y-, (so,,Instructions) - 5 El Commercial/industrial Condition of conveyance f 0 Conveyance which consists of a I El Option assignment c,, surrender (mark an Xin all that apply) mere change of identity or form of ownership or organizetuon(attach m o Leasehold assignm=i-et or surrender a. ©Conveyance of fee interest Form TP-564 1,Schedule F) b El Acquisition of a controlling interest(stateg o Conveyance for which credit for tax n Ej Leasehold gram: percentage acquired—%) previously paid will be claimed(attach c, o Conveyance of an easement Forrn TP-584/,Schedule G) c 0 Transfer of a controlling interest(state , h o Conveyance of cooperative apartment(s) p.o Conveyance for whid- exemption percentage transferred %) from transfer'tax claimed(complete d ❑Conveyance to cooperative housing I o Syndication Schedule B,Part 3) corporation q 0 Conveyance of prop,;ay partly within e. ❑Conveyance pursuant to or in lieu of / o Conveyance of air rights or and partly outside the-state foreclosure or enforcement of security development rights I o Conveyance pursuant io divorce or separation interest(attach Form TP-58-1 1,Schedule E) k ❑Contract assignment s El Other(doscri6e) For recording officer's use - Amount received Date received Transac,*,i number Schedule B,Par',1 _Schedule a.Pat 2 S Page 2,of 4 TP-584(9/19) .Schedelle E—Reab Feturn (Tax Law Article 31) — Part 1 —Computation of tax due 1 Enter amount of consideration for the conveyance(if you are claiming a total exemption from tax,mark an X in the ' Exemption claimed box,enter consideration and proceed to Part 3).._. ... ........ .. .....[:] Exemption claimed 1. 650000 00 2 Continuing lien deduction(see instructions if property is taken subject to mortgage or tier.).. .. .. ... ... .......... ....... ..... 2.1 0 00 3 Taxable consideration(subtract line 2 from line 1) ... ... 3. 650000 00 4 Tax $2 for each$500, or fractional part thereof, of consideration on fine 3........... . .. ............ 4. 2600 00 5 Amount of credit claimed for tax previously paid (see instructions and attach Form TP-584,1, Schedule G) ..... ...... . 5. 0,00 6 Total tax due"(subtract line 5 from line 4) 6. 2600 00 Bart 2—Computation of additional tax due on the conveyance of residential real property for$1 million or more 1 Enter amount of consideration for conveyance (from Part 1,line 1) ....... ... _• 1. 2 Taxable consideration(multiplyfine 1 by the percentage of the prenxses which is residential real property,as shown in Schedule A). . 2. _ 3 Total additional transfer tax due' (multiply line 2 by 1%(.01))...... 3 Part 3—Explanation of exemption claimed on Part 1, line 1 (mark an)(in all boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason, a. Conveyance is to the United(dations,the United States of America, New York State, or any of their instrumentalities, agencies or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or compact with another state or Canada) . . ..... ... ❑ . . .......... .. a b Conveyance is to secure a debt or other obligation .............. . ... b F1. .... ..... ..... ................... . ......... . .. ..... ... c Conveyance is without additional consideration to confirm,correct, modify or supplement a prior conveyance.......... .. .. c ❑ d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty,as bona fide gifts..... . . .. .. ..... .... ...... ...... .. ...... ........ .. . ....... _ d ❑ e. Conveyance is given in connection with a tax sale .... . ............... e ❑ I Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings)Attach Form TP-584.1, Schedule F.......... ... . ..... .1. ....I . .I . f ❑ g Conveyance consists of deed of partition. .. .... . . ... .. ...... .. .... ... . ........•.. ........ . —.... ......... . .... .................. ... g ❑ h Conveyance is given pursuant to the federal Bankruptcy Act.... ...... . „•.•••. _ h ❑ i. Conveyance consists of the execution of a contract to sell real property,without the use or occupancy of such property, nr the granting of an option to purchase real property,without the use or occupancy of such property....... ...... .. ....... . ....... ... ...... i ❑ ). Conveyance of an option or contract to purchase real property with the use or occupancy of such property where the consideration is less than $200,000 and such property was used solely by the grantor as the grantor's personal reside:tc.e and consists of a one-,two-,or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative housing corporation in connection with the grant or transfer of a proprietary leasehold covering an individual residential cooperative apartment... ..... .... . ..... .. .. ..... , , ,. ..•.. J F71.. . ...................... . . ..... ..................... .... , ... k Conveyance is not a conveyance within the meaning of Tax Law,Article 31,§ 1401(e) (attach documents supporting such claim) ...... . .. ... ...... . . * The total tax(from Part 1, line 6 and Part 2, line 3 above) is due within 15 days from the date of conveyance. Make check(s) payable to the county clerk where the recording is to take place For conveyances of real property within New York City, use Form TP-584-NYC. If a recording is not required,send this return and your check(s) made payable to the NYS Department of Taxation and Fina,-2ce,directly to the NYS Tax Department, RETT Return Processing, PO Box 5045,Albany NY 12205-0045. If not using U.S. Mail, see Publication 55, Designated Private Deliveril Services. Page,'of 4 TP-584(9119) Sche-if'Uge C—Credit,Line Iiiiortgatge Certificate (Tax Lavv Article 11) Complete the fiollothring only if the intarest being transferred is a fee simple interest. — This is to certify that (.mark an X in the appropriate box) 1. LL\j The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. ❑ The real property being sold or transferred is subject to an outstanding credit line mortgage However, an exemcElar;from the tax is claimed for the following reason a ❑The transfer of real property is a transfer of a fee simple interest to a person or persons who held a fee simpie interest in the real property(whether as a joint tenant, a tenant in common or otherwise)immediately before the transfe- b ❑The transfer of real property is(A)to a person or persons related by blood, marriage or adoption to the onc;:nal obligor or, to one or more of the original obligors or(B)to a person or entity where 50%or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons(as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). c ❑The transfer of real property is a transfer to a trustee in bankruptcy,a receiver, assignee, or other officer of court d ❑The maximum principal amount secured by the credit line mortgage is$3 million or more, and the real prop�arfy being sold or transferred is not principally improved nor will it be improved by a one-to six-family owner-occupied resvrence or dwelling Note:for purposes of determining whether the maximum principal amount secured is$3 million or more as described above,the' amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See-`SB-M-96(6)-R for more information regarding these aggregation requirements. e ❑Other(attach detailed explanation), 3. ❑ The real property being transferred is presently subject to an outstanding credit line mortgage. However,no tax is=sue for the following reason. a ❑A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed b ❑A check has been drawn payable for transmission to the credit line mortgagee or mortgagee s agent for the 3'alance due, and a satisfaction of such mortgage will be recorded as soon as it is available. 4. ❑ The real property being transferred is subject to an outstanding.credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage) The maximum principal amount of debt or ol'N, atlon secured by the mortgage is .No exemption from tax is claimed and the tax of is being paid herewith. (Make check payable to county clerk where deed will be recorded.) SignatuFe (bOth the gurantors and grantees must sign) The undersigned certify that the above information contained in Schedules A, B,and C, including any return, certification,schedule,.or attachment, is to the best of their knowledge,true and complete, and authorize the person(s) submitting such form on the;r behalf to receive a copy for purposes of recording the deed or other instrument effecting the conveyance. Grantor signature i Title i� rant n lure _ itre � & flu Grantor signature Title i Grantee signature Title Reminder: Did you complete all of the required information in Schedules A, B, and C?Are you required to complete Schedule D? If you marked e,` or g in Schedule A,did you complete Form TP-584 1? Have you attached your check(s) made payable to the county clerk where recording will take place?If no recording is required, send this return and your check(s), made payable to the NYS Depar,`.;+,ant of Taxation ancf Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045,Albany NY 12205-0045. !f not -Ising U.S. Mail, see Publication 55, Designated Private Delivery Services. . Page 4of4 TP-584(9/19) . --__~~~^ .. �"" ,, irom the payment of estimated pers-onal in�ome tax(Tax Law,Artide.22, §663) , OnlY 'afee simple .nterest or acooperative unit sbeing transferred by an individual antataortrust. if the property inbeing conveyed byareferee punsuarittoa forenkmureprooe*ding'pruneedhnPart2' mark onX{n the second-box nxunderExempdonf:rnonx��en��ons�rons�e8arsandaignatb»�»m' Part i -New York State residents |fyou are aNew York State resident transferor/seller listed mForm TP'584. Sohedu|eA(or uno�achment toFonnTP'5B�) youmust Isign =certification uo/mw none urmoetnanah»mnhe||nrofthe real property `yor' `opon�/wa unit ma eNew mwYnrkS�" each resident transferor/seller mu��nignmtheapamapmv/dod �more space ianeeded, photocopy this Schedule Dand o~~wmdaomerm�«hs�uu: /v^nmamn /`eco»aaryzo e»oommodaLe a!| nss/dant8nnafomm/ e||*m / " » -'--__'^... of""s,=e..taa"^sx°xars/semero ^ This is tocertify that at{h*dmeofthe sale ortransfer ofthe real property orcooperative unitthe tran�omnbe|/araosigned below was a eooentofNew York State, and ther�or mnot�qui�dtopay eobmaheUpemnno| muomo `xundnrl�xLuw�083���non1heo | transfer of tiveunihis ^~ sale or Print full name Date im S. Pjalermo-Bogardus' Signature Print full name Ddte Signatu L- Print full name Date Print full name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law 685(c), but not as a condition, of ng- deed Part 2-Nonresidents clNew York State If you are a nonresident of New York State listed as m transfe mf/seller in Fnnn TP-584, SohoduleA(ox an - ^~^ - aMonhme"n to Fcnn TP-584) but butaeno«mqu/mdtupayesMmatedperxnnu|moumehmbsuauoeoneofUhnexomptiono- !owap kesunder7axLawu` 08 (c) mark m'Xm the box ofthe appmphaieexemption below. /fany one ofthe exemphonnbelow applies the t- »femns»Ue�that t~»u"m"°e " snotequ/reUiopuyoat/m�edpemonu|moometmxtoNewYorkStoieunderTaxLaw§063 Each ' ~ ~~/dort transferor/sellai vvho qualifies under one of the exemptions below musi sign in the space provided |fmore space mneeded, photocopy this Schedule "and submit a» many schedules aanecessary toaccommodate all nonresident tranafer m/sv||mm. If none of these exemption statements 'apply,you must complete Form T-2003'Nonresident Real Property Estimated Incn`mo Tax Payment Form, or Form IT-2664, Nonresident C'poperative UW1 Estimated Income Tax Payment Form. For more information,see Payment nfon8nah od' personal income tax, on FormTP'584'|. page 1. Exe m This is to certify that at the time of the sale or transfer of the real property or cooperative unit,the transferor/seller(gra6tor)of this real property or cooperative unit was a n-onresidenc of New York State, but is not required to pay estimated personal income la,,,under Tax Law §663 due to one of the following exemptions [-1 - The real Property o/cooperative unit being sold om � or� erredqualifitotal uner�r'a/s � or'npnnci�jo|pao/denma ' (within the meaning nfInternal Revenue Code, section 111)from 10 �oo�xkoxobn� - to-_- ��---- � L�The transferor/seller/aamortgagor conveying'the mortgaged property 1oamortgagee mfoednsune ormUeuuyfonedoaur� noudd�iona| oonmdan�ion. ' with' F-| The transferor � rororansfeoe'is anagency orauthority ofthe United-States ofAmerica, unagency orauthority ofNewYork State the Federal National Mo�gagoAsnouuhon.the Fedem|Home Loan k�odgageCuqpn�dGovernment � K8 ''onodgaga' Auonciotmn, ora private mortgage insurance company Signature Print full name _-Date _��,gnatur. Print full name Date Print full name Date, Signature Print full name Date ' ' I ,1�Hampton o ( 03 J Slic-fker Island 07 Collrnyt�u�rd`iiC / I"'�' � FV 1 1QPt ���77� i u .itharapton 09 F: 1 lttL 11�11 Proceeds os this transfer tax are disbursed to the �® Tovimships in which the tratisacholi lai„cs place for its::cquisafaon of land,devewpineut rights,and other interests in propert;acr conservation pugvoses, Please punt oriype -- Schedule A information gelating to Conveyance -- — Grantor 1 ame(in.. iwoua,ast, irst,mI d e initis Sooal Security Number Palermo-Bordus,Kitn S E]Individual - E]Corporation [Niadlnga_ddress7 303 Gouverrietir Street — Sca Security Number —v ❑Partnership ((( State ZIP code Feuera!employer Iden I number C]Other I \�orrtstoin; NY 13664 ----�htee Name(Individual,last,first,middle mrtlal) -- _ Individual Ul reenportltd Holdings Inc Scc�al5ecurityNumber til Corporatioa Mailing address 44 Country Club Drive Soc'ai Security iNumber ❑Partnersh,p �I[ ❑Other C'ty State ZIP code Fe-Pral employer Iden _.__ Pori Vdashrnb on i`dY 11050 Location and description of property conveyed Tax map designanon -T--- Address Dist Section glcck Tgt _ Villas= 7—n ] 1000 i 053 00 0400 + 044 036 190 Pheasant Place Gieenpc, I Type of property conveyed((neck appGcabts t,ox) Improved Date of conveyance Dual Tm,ns, (� i Q Vacant land ( I — inon.h dw ve:r Condition of conveyarce(thee-all that app./v) a-Conveyance of fee interest b-Acquisition of a f. -Conveyance which consists of a mere k-Contract assignment controlling interest(state change of identity oi form of ownership or i -Option assignmei�,or surrender percentage acquired organization m.-Leasehold assignment or surrender n.- c-Transfer of a controlling interest(state g-Conveyance for which credit(or tax Leasehold grant percentage transferred previously paid will be claimed o - Conveyance or _,n easement p - d-Conveyance to cooperative housing Conveyance for which;;,emption is corporation h-CQnv g7ce of Cooperative apartment(s)i yn�tca ion claimed(comps rc Schedule B Part 11) y e-Conveyance pursuant to or In lieu of ) -Conveyance of air fights or development q-Conveyance of roper foreclosure or enforcement of security rights p ypartlywrthinand interest partly without i.estate r -Other(desct ibe)— Schedule B --Community Preservation Fund Computation of Tax Due —— -- 1 Enter amount of consideration for the conveyance(fiont line I TP584 Schedule B) 1 650,000.00 2.Allovvance(see below) I 2 150,000 00--- 3 Taxable consideration(st,btiact line 2 fiom hne'l) 3 500,000 00 4.2%Community Preservation Fund(of line 3)make certified check payable to SMITOLK COUNTY CLERK 5.Property not subject to CPF Tax.(See Schedule C) 4 ]0,000 00 s F�r cording officer's use Amoun;received Date received c. Tranc;ruon number Allowance. East Hampton $250,000 00 improved $100,000 00 Vacant Land(Unimproved) Shelter Island $250,000.00 Improved $100,00000 Vacant Land(Unimproved) Southampton $250,000.00 Improved $100,000 00 Vacant Land(Unimproved) Riverhead $150,000 00 Improved $75,000 00 Vacant Land(Unimproved) Southold $150,00000 Improved $75,000 00 Vacant Land(Unimproved) I[-UZ i3-U9(Uicg Schedule - C - (continued; _ Part R-Explanation of Exemption Claimed in Part 1,line 1(check any boxes that apoly) The conveyance of real property is exernptfrom the real estate transfer tax for the following i eason a Conveyance is to the United Nations,the United States of America,the state of New York or any of their instrumentalities agencies or political subdivisions (or any public corporation, including a public corporation created pursuant tc agreement or I� compact,vith another state or Canada) LJ b Conveyance is to secure a debt or other obligation c Conveyance is withbut additional consideration to confirm,correct,modify or supplement a p•ioi conveyance u d Conveyance of real property is vithout consideration and not in connection with a sale,including conveyances conveyor,� realty as bona fide gifts e.Conveyance is given in connection wuh a tax sale . f.Conveyance is mere change of identity or form of ownership or organization where there is no change in beneficial owne*,hip (This exemption cannot be claimed for a conveyance•to a cooperative housing corporation of real property compra:ng the cooperative dwelling or dwellings) g Conveyance consists of deed of partition h.Conveyance is given pursuant to the federal bankruptcy act ❑ i.Conveyance consists of the execution of a contract to sell real property without the use or occupancy of such property or rhe granting of an option to purchase real property without the use or occupancy of such property j.Conveyance or i eal propemy which is subject to restrictions which pi ohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) of (k) of Article 31-D of -he Tax Law (See required Town approval,below) x.Conveyance of real property f(,r open space,parks,or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation,environmental,or historic presen'ation purposes I Other list explanations in space below(Grandfather/Contract) m Conveyance of real property as a primary residence where the grantee is a first-time homebuyer (attached approved application) n.Conveyance of real property to a tax exempt,not-for-profit corporation for the purpose of providing affordable housing (� o The conveyance is approved for an exemption Fran the Community Preservation Transfer Tax,under Section 1449-ee of _1 Article 31-D of the Tax law (Seej in Schedule Q Town Attorney or other designated official Penalties nnd Itrsf�s-est Penalties �a.teres; Any grantor or grantee failing to lile a return or to pay any tax within Daily compounded interest will be chaiged on she amount of the the time regwied shall be subject to a penalty of 10%of the amount tax due not paid within the time required of tax due plus an interest penalty of 2% of such amount of each month of delay or fracuon thereof after the expiration of the first month after such return was required to be filed or the tax becarne due However,,the interest penalty shall not exceed 25% in the aggregate. Signature (both the grantor(s) and grantee(s), MLIO sign) The undersigned certify that the above return, including any certification, schedule or attachment, is to tna best of his/her knoyaledge,true complete Granto'--------------- ,ra — l G-, nC. T -'— - rantee`�' •— 12-0215 09101rg FOR COUNTY USE ONLY fNSTR1JCTIONS(P,P-5217-PDF-MS) www Orps state ny us 1 C'. 5Vd15 Code New York State Dep"n gent of rS ` f _ I Taxation and F,,,-ance C2.Date Deed Recorded / � tt Office Of Real Prope, Tax SeivlCes Mo�ln oay vea. tpt C3 Gook [_ �!.. amP^62. ,t JPD F C4.Page 1 P.eal Property Transf.,Report(8110) PROPERTY WFORFlIATIOhl - 1.Property 1 rJ Location Pheasant Place STREET NUM]ER 'STREET MAPAE - Southoln GreenpOrL 'CITY 11944 VILWGE •LIQ CODE 2 Buyer Greenport W. Holdings Inc. Name 'As-IJAMEICONPAN\ FIPST NOME ' WS f N V IC/�C`APAN� iRci NAME 3 Tax Indicate where future Tax Bilis Erato be sent BillinggIf other than buyer address(at bottom of form) --- Address ir'ai�ISMrIf OYPAh, - -- FIRUT NAME t•TREET--DER<ND NAME OITY OR I uwN ` STATE LIP LOGE 4 Indicate the number of Assessment T (Only if Parc of a Parcel)Cas a Roil parcels transferred on the d-ac_ of Parcels OR Pen or a Parcel heck The Y PPl'! S.Deed VA Plano:ng Board wdh Subdivision Authority EXisto El Property FRONT FEET ,X ':oEPiH t�p /J.,\c9 s 46 Subdmslon Approval was Required for Transfe Size EJ 4C Parcel Approved for Subdivision will,Nap Pro,clad Palerme-B garde G Kim S. Name Ll\$T N:J/U:O tIP.,fJY anle FIRST—NAME - -•— LAST tJAV F�,^,O•IP�N r FIRST NAME '7.Select the description which most accurately describes the Check the no:'es below as they apply use of the property at the time Of sale. S.Ownershp Type is Condominium A One Fanul: ResLderual s New Construction on a Vacant Land --- 10A Property Located within an AgncWtural District 108 Buyer received a disclosure notice indicating the,Lr_-property Is in an ! 49noultural District i SALE hdFOKMATION 9 — ��'�''•�-� 15 Check one or more of these conditionsas 7pptic..Ac to transfer A Sale Between Relatives or Former Relatives 11 Sale Contract Date _ 12/06/2019 B Sale beh's,Related Companies or Partner I i 3uslness COne of the Buyors Is also a Seiler °12.Date of Salerrrans far O Buyer or Seller is Govemman,Agency or Lend,g InsktuGcn E Deed Type not Warranty or Bargain and Sale'S:safy Below) F Sale of Fractional or Less than Fee Interest(Sp-,,fy Below) '13 Full Sale Praco - 650,000 QO G Sigtnficant Change In Property Between Taxatie Status and Sale Dates H Sale Of Business is Included in Safe Price {Full Sale Pnce is the total amount Pard for the croperty,Including personal property 1 Other Unusual Factors AffectinSale Price This payment may x in tie Corm of cash Other property or goods,or the assumption of 9 Below) J Nonemortgages or other cNigations)Please round to the nearest whole dollar amount Cornment(s)on Condition 14.Indicate the value of personal property Included in the sate .00 f7SSESSb1EN INFORIMATION-Data should reflect the latest Fnal Assessment Roti and Tax Bill i 16 Year of Assassmont Roil from which information taken(YY) 1 G '17 Total Assessed Value 6,450 15 Property Class 710 _ _ '19 School District Name p Green ort '20 Tax Map Idenb9er(s)/Roil Identifar(s)(If more than four,attach sheet with additional identifier(s)) 1000-053.00-0-1.p0-Jy4 Glc CERTIF(CATIONi -- I Certs`)/that all of the items of Information entered on this Farm are true and correct(to the best of my knowledge and belief)and I understand th itlm,�;Waking of any willful false statement o�,materia!tact hers,,subject me to the orovfs-_eels of] g al[_I I�w relative to the malting and filing of false instruments ' ))) SELLE R/..•S•'�'�IGAIA—TLI BUYER CONTACT IWFORMAT*••- - 1 (Enver Informal-for the buyer Note If buyer Is LLC,snaety,assoaalfon,cerPoroM1on,jo.n•,Iccl;company,estate or n` ) entity Inet Is not an Individual a,,rl or m-tiry,lien a name and contact Inti tion or-.ndlmdualln sponslble ✓ /j �L J, /�\A! ✓1`�� � party who wn anSner quesLons regatdu p m,transfer must bo rt-d Typo orprint cl-ly) SELLER Se101.ATURE '(•! O•,E S!J"ErSSIGNA]IR- Pagnozzi Rcoert •LAST NAME FIRST NAI4E t) Y9�Ui 7118) 461-6633 YER SY'N�TURE n PEA100E •TELEPHOIIE NW'DEP JE.99%&-t) U � L�4T y 113( 7 7Dy 44 Country Club Drive r i lJ U •STRCET hI/MeEP •STREE71Ir ME r�'1 If.l i( trlt'l-] L ]I y�t 1I t 41' yit� t 1 1Port 7 �n ton Al 11056 'Cin OR silt. nacooE�, ( _ a 'll r ' rw}>af) t fi {IDy y 7JE I IIiJ�,q; '^(Set o lid#°• BUYER'S ATTORY )!i() fjj({{ I t GrOssman/ Esq. Jack pI }iL`f IIID (()l� l' l ll1l L�IIIIsI,;JLI �iI �� �,�i,� (,'�rp'T)Yal- LASTNAME Sill I 1 � 1� I���f JCjj11�tI fII[i54(,r(r.�F,/Jl ry)�y)L7,�1(1�rrlI Gf�lil�rr flf 1 i I FIR:rT NAME ;$�I s '� . !j 4� 'i `�� ➢l f 1`"`5Y'ti�`{ifd 4;1• C17'�7}!�E}1R9r t { (718) 461-6633 (}{;;�� p( Iliy�iy{R •,Ii 14,1j1't �1; (Iia�`�y#d�,�` ¢1{(9j'tbp 1� �,: AREAcooe TCLEP-1E NUMCER `�I)�� fe��d��IC V�G�rrL�(P6�d��rl��l}��lt�(i`Ir'Si Ittl'•Y11il�a�)I�t1!II