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OCgufFOlk Town of Southold 9/10/2020 0 P.O.Box 1179 c T 53095 Main Rd �Dy.�jo� Southold,New York 11971 ji fXIJ-1 CERTIFICATE OF OCCUPANCY No: 41427 Date: 9/10/2020 THIS CERTIFIES that the building AS BUILT APARTMENT Location of Property: 1570 Bray Ave.,Laurel SCTM#: 473889 Sec/Block/Lot: 126.-7-26.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/3/2020 pursuant to which Building Permit No. 44788 dated 3/13/2020 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for t which this certificate is issued is: "as built"second floor accessory apartment with deck in an existiing accessoH _garage as applied for per ZBA 6763 dated 8/21/2014. The certificate is issued to Burke,Thomas&Kathleen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-19-0048 1/31/2020 ELECTRICAL CERTIFICATE NO. 44738 3/3/2020 PLUMBERS CERTIFICATION DATED 7/15/2015 �niQattitucllumbing& atmg o ignature TOWN OF SOUTHOLD o�osuFfotr �ou y BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy • 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#: 44788 Date: 3/13/2020 Permission is hereby granted to: Burke, Thomas 1570 Bray Ave Laurel, NY 11948 To: to legalize an "as built" accessory apartment in an accessory garage as applied for per ZBA and SCHD approvals. At premises located at: 1570 Bray Ave.,Laurel SCTM #473889 Sec/Block/Lot# 126.-7-26.1 Pursuant to application dated 3/3/2020 and approved by the Building Inspector. To expire on 3/13/2021. Fees: CO-ACCESSORY BUILDING $50.00 AS BUILT-ACCESSORY $740.80 Total: $790.80 Builliq Inspector a ' �VFFQ�,� BOARD MEMBERS ® C� Town Hall Annex Leslie Kanes Weisman, Chairperson f.� �� 53095 Route 25,Main Road Patricia Acampora P.O.Box 1179 Eric Dantes Southold,NY 11971 Robert Lehnert,Jr. Telephone(631)765-1809 Nicholas PlanamentoQj ��®> Fax(631)765-9064 http://southoldtownny.gov ZONING BOARD OF APPEALS ------ TOWN , -TOWN OF SOUTHOLD �(� i r J U N - 8 2021 MEMORANDUM To: Zoning Board of Appeals Members Mike Verity, Chief Building Inspector From: Kim E. Fuentes, Board Assistant Date: June 8, 2021 RE: Elmendorf, 1570 Bray Avenue, Laurel #7484SE—Accessory Apartment- SCTM No. 1000-126-7-26.1 Please see the attached documents submitted by the above referenced applicant pursuant to the conditions of his Special Exception approval, listed below: 1.Revised site plan (stamped) illustrating three(3) on-site parking spaces as required by code. 2. A notarized AFFIDAVIT to the Zoning Board of Appeals stating the unit is to be rented to a resident who is currently on the Southold Town Affordable Housing Registry and eligible for placement. 3. A letter submitted to the Zoning Board of Appeals from the Town Government Liaison Officer indicating that a tenant (Delia Sarich) was selected from the Affordable Housing registry and that a lease was completed. I will make these documents part of the Laserfiche file. JOB No. 15457 - A13049 SUFFOLK COUNTY TAX MAP NOTE: DISTRICT 1000 1. LOTS SHOWN REFER TO 'MAP OF SECTION 1 PROPERTYSECTION 126,00 OF GNo861. TUT6HILL AND OTHERS', FILED JANUARY 15, 1929 ()0 BLOCK 007.00 MGN PARCEL 026.001 Vol 5� - DRp,\N RECEIVED E°<t"ec\y 7L ES 1 tt Ooh Of •((RVp� o�\R� O r pP��p P�PN�56 F�eN GRv6PE HEDGE odff 5A Q 12—al O FEN / moMSE O PRBG Z®�1frlg Board of Ap y( E I A Off'`� � NG,�ER G �`G�v 69. 3 ` \ N \\ sHEG y �� ----- ----------GAS n..- F°ALTERATION OR c•�;' FEN 01. C� A hr BEARING A LICENSED LAND D 5NN N 5(F�R �SE ---- SUS ''R'S SEAL IS A VIOLATION OF SECTION G MON FO 5 E C ?��� NO / `-O N 720n c•�n_r••;�SION 2,OF THE NEW YORK 0 F ' EDU'5';ON LAW COPIES OF THIS SURVEY MAP NOT BEARING THE 2 \ \GKwPy- LAND SURVEYOR'S GREEN INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. O, CERTIFICATIONS INDICATED HERON SIGNIFY THAT THIS SURVEY WAS PREPARED 1N ACCORDANCE WITH !NAL MAP THE EXISTING CODE OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF (r \ PSPNP� opp �jE PROFESSIONAL LAND SURVEYORS SAID CERTIFICATION! O, SHALL RUN ONLY TO THE PERSON FOR WHOM THE / \ \ QECK Qp��O i i •O SURVEYS PREPARED AND ON HIS BEHALF TO THE Z C - !E W E D B A 1 TITLE COMPANY.GOVERNMENTAL AGENCY AND LENOIND \ \ ` /h �` - __: -,LS�t6 WP�K ^ A'INSTIEITION LISTED HEREON,END IFASSIGNEE'S THE LENDING INSTITUTIONTUTION CRTIFI ATIO S OF THE ARE NOT �] 1 --i- G�55 E DEC I S I Ol TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR (\ E\EG / \ SUBSEQUENT OWNERS G JES a E ATEDA /I \ Eo G5-7 t MAP OF PROPERTY FOR ° s BYRON ELMENDORF NLLAND 1w f 0 % aa�'Tq `eR-�L�, � �� A, F y h y Q �o� sa ;— S & MIRANDA CAPRIOTTI �o o G\ SITUATE SURVEYED: MAY �, No. G G SPACES SHOWN) �o SUR +� MATTITUCK SURVEYED: MAY 1 the Stade ' S fo-q TOWN OF SOUTHOLD ROBERT A. SMITH, L.S. 49239 ' SUFFOLK COUNTY, NEW YORK S. H. W. and S., LAND SURVEYORS P.C. SQUIRES, HOLDEN, WEISENBACHER & SMITH AREA = 15,000 S.F. (0.344 ACRE) LAND SURVEYING — LAND PLANNING — ENGINEERING SCALE: 1" = 20' SOUTHAMPTON — NEW YORK t 15457dwg B 857 P 108,109 7021 GENERAL AFFIDAVIT '`'' As the property owner of 1570 Bray Avenue, Laurel, NY, I, Byron Elmendorf, attes "I t a° e accessory apartment located on that property shall be occupied by a resident who is currently on the Southold Town's Affordable Housing registry, and is eligible for placement, evidenced by a written lease,for a term of one or more years. Owner Signature: STATE OF NEW YORK COUNTY OF SUFFOLK Sworn before me on this day of Ave; (Notarylic) �b f vim.[� AOA- eV ,rJ /�i��� &J, X130 . JONATMN D. FOGARTY Notary Public•State of-New-York NO.01F062141421 Qualifed in Suffolk county r12 My Commission"Expires May 23,2QL, t c ' DENIS NONCARROW }q Town Hall, 53095 Route 25 Government Liaison Officer - P.O.Box 1179 Southold, New York 11971-0959 A� Fax(631) 765-1823 Telephone(631)765-5806 OFFICE OF THE SUPERVISOR TOWN OF SOUTHOLD RECEIVED 6/3/2021 Southold Town Zoning board of appeals. Zoning Board of Southold Town Annex Appeals Main Road. Southold N.Y. 11971 The individual known as Delia Sarich is on the Southold Town housing Registry and meets all the criteria to rent the apartment at 1570 Bray Avenue, Laurel NY. Thank you Denis Noncarrow Government Liaison Officer. Town of Southold. Noncarrow, Denis From: Delia Sarich <delia.sarich@gmail.com> Sent: Thursday, May 20, 2021 11:40 PM To: Noncarrow, Denis Cc: Miranda Capriotti Subject: [SPAM] -W-2 &Tax forms/1570 Bray Ave Application Attachments: Taxw2.2020.pdf,taxform.pdf, 2020_TaxReturn (1).pdf Hello Denis, I am writing to submit my 2020 W-2 forms/tax return information to be considered as a tenant at the following address: 1570 Bray Avenue, Garage Apartment Laurel,NY 11948 Please see attached for W-2 &tax return information. Because of the pandemic,I have only a partial year income. I also have a 1,099 form for$13,000 in unemployment benefits received in 2020. Do you need that file as well? I am currently employed as the Tasting Room Manager at Bridge Lane Wine, 35 Cox Neck Road,Mattituck, with an estimated yearly salary of$72,000. Thank you for your time, and please let me know what else I can do to Help the process. Cheers, Delia Sarich 'EeEIVED Ji JN g zo Yd of Zoning Boa ,APO-a1� i o�SUFFo1 TOWN OF SOUTHOLD aye BUILDING DEPARTMENT N $ ' TOWN CLERK'S OFFICE SOUTHOLD, NY 0 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#: 44738 Date: 2/27/2020 Permission is hereby granted to: Burke, Thomas 1570 Bray Ave Laurel, NY 11948 To: Electrical survey. At premises located at: 1570 Bray Ave., Laurel SCTM # 473889 Sec/Block/Lot# 126.-7-26.1 Pursuant to application dated 2/27/2020 and approved by the Building Inspector. To expire on 8/28/2021. Fees: ELECTRIC $125.00 Total: $125.00 Building Inspector r� 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 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. �� L�, New Construction: Old or Pre-existing Building: (check one) Location of Property: 15-10 -d�'�r 4 j1�r�t-2 House No. Street Hamlet Owner or Owners of Property: A% Suffolk County Tax Map No 1000, Section Block Lot a`Z Subdivision/'✓Lzf f c F�� I Fa*a-:*ak of G..z, l emigFiled Map. 41o, 9'6 Lot: �S- Permit No. qq1 ff Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ U fy Applicant Signature CONSENT TO INSPECTION the undersigned, do(es)hereby state: Owner(s)Name(s) That the undersigned(is) (are)the owner(s) of the premises in the Town of Southold, located at Uczq c`3 B kA-vE- LAtk9a A/5� lIV(8 , which is shown and designated on the Suffolk County Tax Map as District 1000, SectionCom, Block , Lot 1 . That the undersigned(has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: That the undersigned do(es)hereby give consent to the Building Inspectors 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. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: d / 1 t (Signature) fe,.n M, (Print Name) (Signature) (Print Name) �o�a0f souTgolo 713 19 70 -6rve V Ave # TOWN OF SOUTHOLD BUILDING/DEPT. 765-1802 INSPECTION- FOUNDATION1ST [ ] 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 ] PRE C/O REMARKS: / y cover an aorl�A Cot DATE INSPECTOR �, i �aoe souryo # # TOWN OF SOUTHOLD BUILDING DEPT. o • �yco 765-1802 INSPECT-ION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND INSULATION/CAAULKING [] FRAMING /STRAPPING [i/] FINAL f# th* IICL• Al Ov11 [ ] FIREPLACE-& CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL(ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O 4V REMAR S: ��C/Li .� 44t 0 Y RPF' �&kv< L vJ t cvyveq DATE ?'U INSPECTOR OF SOGI�olo # # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROU PLBG. [ ] FOUNDATION°21SID [ ] SULATIOWCAULKING [ ] FRAMING/STRAPPING ] FINAL ]-FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION j ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL.(ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: . DATE. INSPECTOR oF soUP�®l Town Hall Annex OIL ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ® �� sean.devlin(-W-town.southold.ny.us couff N' BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To Thomas Burke Address: 1570 Bray Ave city,Laurel st: NY zip: 11948 Building Permit#. 44788 Section- 126 Block- 7 Lot: 26.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: ICE Electric Inc License No: 4586-ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor X Hot Tub Addition Survey Attic Garage X INVENTORY Service 1 ph X Heat Gas Duplec Recpt 13 Ceiling Fixtures 1 Bath Exhaust Fan Service 3 ph Hot Water Gas GFCI Recpt 1 Wall Fixtures 3 Smoke Detectors 1 Main Panel 200A A/C Condenser Single Recpt Recessed Fixtures 9 CO2 Detectors 1 Sub Panel A/C Blower Range Recpt Ceding Fan 1 Combo Smoke/CO 2 Transformer UC Lights Dryer Recpt 30A Emergency Fixtures Time Clocks Disconnect Switches 16 4'LED 1 Exit Fixtures Pump Other Equipment: Mlcro,Fridge, Oven, DW, W/D, Gas Heater, Heat Lamp Notes Electrical Survey " AS BUILT " " NO VISUAL DEFECTS " Apartment Over Garage Inspector Signature: Date: March 3, 2020 S Devlin-Cert Electrical Compliance Form.xls l Telephone(631)765-1802 1z2r(6311 7&L"09 P.O.Box 1179 Southold,NY 11971.0959 BU MING DEPARTMENT TOWN OF sOUTHOLD MAR - 3 2020 CERTIFICATION ' Date: '7 Building Permit No. b Owner: / 1 �Rw4a-� � �E (Please print) Plumber: fij .Iac.- �� (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. 1 ,5110 `1 fL Al� f &IF 73 UITL (Plumbe Sworn to before me this day of V I , 20 IS CHEL`SEA L. CHALONE Notary Public,State of Nev'York Registration #01 CH6287106 Qualified in Suffolk County commission Expires August 5,2017 Notary Public,�U+W)�L- County Edward Armus Engineering, PLLC 36 Deer Run Water Mill, NY 11976 631-804-6267 ed@armusengineering.com Memo To: Town of Southold Building Department From: Edward Armus, PE D D CC: File, Owner Date: 8/26/2020 AC'; 2 7 2020 Re: 1570 Bray Avenue, Mattituck BUILDMIG TM SCTM: 1000-126-07-026.001 TCV"i:C'S' �Y ®LD Notice of Inspection Hi, As per the Building Department inspection notice dated 6/5/2020, 1 reviewed the outstanding item 1, 2, and 3 for conformance. Item 1 — The structure satisfies code compliance for insulation installed at the conditioned spaces, plumbing waste lines are watertight and vented, and footings installed at the entry deck. Item 2 —The stair openings do not exceed the allowable 4" spacing and a graspable handrail is present. Item 3 - The bedroom has an operable egress window meeting the current height and width code requirements. Please contact me with any questions or comments. OF NEIY Thank you. o�PPo P qq�0 r � [C Edward Armus, P m2 W2 Edward Armus En o �n9dko baaio6 ROTES S10NP Page 1 of 1 FIELD INSPECTION REPORT DATE COMMENTS C FOUNDATION(1ST) y -------------------------------- FOUNDATION (2ND) . ® o ROUGH FRAMING& gem �o PLUMBING y i INStiLATION PER N.Y. '3 STATE ENERGY CODE • AA) AO A14 irAl 0 FINAL b I/ I yz ADDITIONAL COMMENTS 1 a �� ��b Q ® t��0 � 2-2)✓ d , m ® y , lov x . - a b � y TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following, efore applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 Additional 4 sets of Building Plans TEL: (631) 765-1802 Certification Planning Board approval FAX: (631) 765-9502 �a�/ Be f Survey Southbldtownny.gov PERIVIIT X10. `� Check / Septic Form 9 N.Y.S.D.E.C. Additional Trustees C.O.Application ^.Certification Flood Permit Examined 20 r" Single&Separate ~. 0 Required. Truss Identification Form ?' Storm-Water Assessment Form Contact: _ Appioved ( 20ham✓ Mail to f "/m kt/Le Disapproved a/cS_'�O RAAT A-LsL ' Phone: G31 £gip( ItgY9 Expiration 20 �('�� _ � (�3l X55 I a�5 i Insp APPLICATION FOR BUILDING PERMIT Date L , 202-9 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 shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose 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 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 inspections. (Signature of applicant or name,if a corporation) �7 U_ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed ork will be done: S v 2 House Number Street Hamlet County Tax Map No. 1000 Section Block Lot CL /4if P 0FYtC771aeO1 Subdivision 10/1 4Pz.`t�, c91= &,Z 1,41ATLI 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 '51 C f-F—_49 ti,`i"1 °5 _ n_UA� b. Intended use and occupanc1 I I "CCR3. Nature of work(check which applicable): New BuildingAd rtion Repair Removal Demolition),-,, 7•,_ Other Work (Description) 4. Estimated Cost 'Fee J (To be aid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units of 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 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 ) t Rear 1 01-0 1 Depth 10. Date of Purchase Name of Former Owner "R IR 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO / 13. Will lot be re-graded? YES NO excess fill be removed from premises? YES NO ✓ 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY B�PQUIRED. 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 OFS (K ) ' & :110- rrn ffj RU1-1�.� being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the (Contractor, Agent,Corporate Officer, etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this I, �c1 day of fc , 20,20 12 TRACEY L. DWYER Notary Pu is NO.O1DW630 900STATE OF E Signature of Applicant QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2D&9,_ r�. BOARD MEMBERS OF S (/l Southold Town Hall Leslie Kanes Weisman,Chairperson 53095 Main Road•P.O.Box 1179 hO l0 Southold,NY 11971-0959 Eric Dantesic Office Location: Gerard P.Goehringer G Town Annex/First Floor,Capital One Bank - George Horning �� Y� 54375 Main Road(at Youngs Avenue) Kenneth Schneider �yCQut�(,� Southold,NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel.(631)765-1809•Fax(631)765-9064 FINDINGS,DELIBERATIONS AND DETERMINATION MEETING OF AUGUST 21,2014 ZBA Application No.: 6763 Applicants/Owners:Thomas and Kathleen Burke- Property Location: 1570 Bray Avenue(comer Fourth Street),Laurel,NY SC-TMV 1000-126-7-26.1 SEM DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type 1I category of the State's List of Actions,without further requirements under SEQRA. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was not required to be referred to Suffolk County under the Suffolk County Administrative Code Sections A 14-14 to 23. LWRP DETERMINATION: The relief, permit, or interpretation requested in this application is listed under the Minor Actions exempt list and is not subject to review under Chapter 268. REOUEST MADE BY APPLICANT:The Applicant-Owner requests a Special Exception under Zoning Code Section 280-13(B)(13)to-establish an Accessory Apartment in an existing-accessory structure. PROPERTY FACTS/DESCRIPTION: The subject property contains 15,000 square feet with 100 feet along Bray Avenue, 15-0 feet on Fourth Street, 100 feet on the West side and 150 feet on the North Side. The property is improved with a single-family two-story residence and a two story accessory structure. All is shown on a survey by Paul T.Moore L.L.S.dated October 1, 1986 and last revised August 30, 1989. The accessory structure has a CO of record dated June 23, 1981 under Certificate of Occupancy #ZI 0535 confirming that the accessory garage was built prior to January 1,2008. ADDITIONAL INFORMATION: The applicant's neighbor spoke against the application. He had concerns about the shrubs limiting the driver's visibility on the e street entrance to the property. The applicant testified that she will maintain the shrubs and maintain a clear line of sight along the 4"'street entrance. She also testified that 4'h street is a dead end road with little traffic. The apartment is currently rented to the applicant's cousin. Page 2 of 3_August 21,2014 ZBA#6763 -Burke SCTM#1000-126-7-26.1 FINDINGS OF FACT: The Zoning Board ofAppeals held public hearings on this application on July 10 and August 7,2014,at which time written and oral evidence were presented.Based upon all testimony, documentation,personal inspection of the property and the surrounding neighborhood,and other evidence,the Zoning Board finds the following facts to be true and relevant. In considering this application,the Board has reviewed the code requirements set forth pursuant to Article III, Section 280-13(B)(13)to establish an Accessory Apartment in an Accessory Structure and finds that the applicant complies with the requirements for the reasons noted below: 1. The Accessory Apartment unit will be located on the second floor of the accessory garage with an area of 628.26 square feet of livable floor area°in conformity,4� rop9sed;as described and shown on the floor plan and confirmed by the Building Inspector in a memoran um titled"Verification of Livable Floor Area"dated June 5,2014 and received by the Board of Appeals on June 16,2014 2. The dwelling unit complies with the definition of same in §280-4 of the code and complies with the code requirements as defined in Section 280-13(B)(13) of the Zoning Code.The owner confirms that the accessory apartment shall not contain less than 450 sq. feet nor will the accessory apartment exceed 750 square feet of livable floor area,all on one floor with only one full bathroom. 1 The applicant herein, owns and resides at the property and will continue to occupy the single-family dwelling as a principal residence in conformance with the code requirements as set forth in Article III, Section 280-13(B)(13)0, 1-4), and as documented by 2013 Town and County tax bill and a photocopy of Kathleen Burke's driver's license. 4. The occupants of the accessory apartment will be either a family member or a resident who is currently on the Southold Town Affordable Housing Registry, and the occupancy shall not exceed the number of persons permitted,in conformance with the code requirements as set forth in Article III, Section 280- 13(B)(13)0, 1-4). In a notarized affidavit dated May 29,2014 by Kathleen Burke stated that her cousin, Carol George rents the apartment. At the hearing Ms.Burke testified that Ms. George's lease expires at the end of August and that it is her intention to keep Ms.George as a tenant,if she wishes to,or to rent to a person who is on the Town's Affordable Housing Registry,per code. 5. The owners' plans comply with the on-site parking requirements and provide for a total of three (3) parking spaces, two for the principal use and one for the Accessory Apartment, utilizing the existing driveway areas, as shown on the site plan or survey by Paul T. Moore dated October 1, 1986 and last revised August 30, 1989. 6. Only one accessory apartment will be on the subject property and no Bed and Breakfast facility, as authorized by Section 280-13(B)(14) hereof shall be permitted in or on premises for which an accessory apartment is authorized or exists. 7. This conversion shall be subject to a building permit, inspection by the Building Inspector, and annual renewal of the Certificate of Occupancy. REASONS FOR BOARD ACTION DESCRIBED BELOW: Based upon all testimony, documentation, personal inspection of the property and surrounding neighborhood, and other evidence,the Zoning Board finds the following facts to be true and relevant: 1) The Accessory Apartment, as applied for, is reasonable in relation to the District in which it is located, Page 3 of 3_August 21,2014 ZBA#6763 -Burke SUM#1000-126-7-26.1 adjacent use districts,and nearby adjacent residential uses. 2) This Accessory Apartment shall be in conjunction with the owner's residence in the Accessory structure, and as proposed will not prevent the orderly and reasonable use of districts and adjacent properties. 3) No evidence has been submitted to show that the safety, health,welfare, comfort, convenience, order of the Town would be adversely affected. 4)The special exception is authorized under the Zoning Code through the Zoning Board of Appeals as noted herein,and issuance of a Certificate of Occupancy from the Building Inspector is required by code before an Accessory Apartment may be occupied. 5)No adverse conditions were found after considering items listed under Sections 280-142 and 280-143 of the Zoning Code. BOARD RESOLUTION: On motion by Member Dantes,see onded by Member Schneider, it was RESOLVED,to GRANT a Special Exception-for an Accessory Apartment,-in the existing Accessory Structure, as applied for. SUBJECT TO THE FOLLOWING CONDITIONS: 1. This Special Exception Permit requires an annual renewal by December 31st of each year from the Building Department. It is the applicant's responsibility to apply to the Building Department before December 31" and renew the accessory apartment permit. Failure to do so may require a public hearing before the Zoning Board of Appeals to review potential action to revoke the Special Exception Permit granted herein. That the above conditions be written into the Building Inspector's Certificate of Occupancy,when issued. NOTE: This Special Exception•permit cannot be transferred to new owners Any deviation from the survey,site plan and/or architectural drawings cited in this decision,may result in delays and/or a possible denial by the Building Department of a building permit,and may require a new application and-public hearing before the Zoning Board of Appeals. Any violations of the conditions, occupancy or other requirements described herein,may require a public hearing before the Zoning Board of Appeals to review potential action to revoke the Special Exception Permit granted herein. Vole of the_Board.• Ayes: Members Weisman (Chairperson), Schneider•, Horning, Goehringer, Dantes. This Resolution was duly adopted(5-0). Leslie Kanes Weisman, Chairperson Approved for filing Y1d 6 /2014 Scott A. Russell ��°su p STO]KI��1 WA\`]C']EIK SUPERVISOR AMI A\N A.G]EM1EN T SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE�COMPLETED BY THE APPLICANT ) DOES THIS PROJECT EC T INVO LVIE ANY OF THE FOLLOWING: Yes o (CHECK ALL THAT APPLY) N ' ❑ A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. E][2/B. Excavation or filling involving more than 200 cubic yards of material ( within any parcel or any contiguous area. ❑ C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ' ❑[D/D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑ E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. E][2/F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT. (Property Owner,Design Professional,Agent,Contractor,Other) S.0 T.M. #: ]000 Date p NAME � -v�t /TS �t� a.b a(o a i 2 1 1 20 Section Block Lot FOR BUILO1N6 DEPA R-1-NIENT 1,SE c_NL'( ••"• Contact Information Reviewed By: / {� Date: 3 �0 Property Address / Location of Construction Work: XApproved — — — — — — — — — — — — — — for processing Building Permit tormwater Management Control Plan Not Required. ❑ Stormwater Management Control Plan is Required (Forward to Engineering Department for Review.) FORM 11 SMCP-TOS MAY 2014 math a uNa ��SUFFOL,f-�o BUILDING DEPARTMENT- Electrical Inspector a0 GymTOWN OF SOUTHOLD CD Town Hall Annex - 54375 Main Road - PO Box 1179 u' Pry - Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(a southoldtownny.gov - sea nd[o)southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ali information Required) ,`Date Company Name: _!�_ �c7���C �N,c ho s ; i + stt i.�.- Name: �, �'�� oy, -' 9FEB 2 2020 �-' License No.: email: �� /� email: Address: et!: vP�" ✓ 1. �;�li,1N`tl.,rf ;1--' a Phone No.: e,131 JOB SITE INFORMATION (All Information Required) Name: 5�-, Address: / rd Cross Street: Phone No.: Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: T.TI BRIEF DES RIPTION OF WORK (Please Pr' t Clearly) �ec/ ,%� c✓ �/f I d• Circle A( hat Apply: Is job ready for inspection?: ES NO Rough In Final, Do you need a Temp Certificate?: YES / � Issued On Temp Information: (All information required) Service Siz 1 Ph 3 Ph Size: A # Meters Old Meter# New Service - Fire,Reconnect - Flood Reconnect - Service Reconnected - Underground - Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION ( �,b . Request for Inspection Form.xls \�.� v\� Thomas Burke From: noreplyehims@suffolkcountyny.gov Sent: Friday,January 31, 2020 9:29 AM To: SHWS@HAMPTONS.COM; SHWS@HAMPTONS.COM;tburke55@optonline.net Subject: Project SCDHS Ref#: R10190048-ZEC Approval of Constructed Works The Department has reviewed your final documents, Ref #: R10190048-ZEC, and has issued an Approval of Constructed Works. Thank you. Office of Wastewater Management CONFIDENTIALITY NOTICE: This electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and may contain confidential information belonging to the sender which is protected by the attorney-client privilege. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error, please notify the sender immediately by e- mail and delete the original message. JOB No. 15457 N A13049 \ o�E SUFFOLK COUNTY TAX MAP . I L�L�3 NOTE: \ DISTRICT 1000 i \ SECTION 126.00 1. LOTS SHOWN REFER TO 'MAP OF SECTION 1 PROPERTY M°N BLOCK 007.00 OF G.I. TUTHILL AND OTHERS', FILED JANUARY 15, 1929 I 00 \ MAP No. 861. �5�' ♦N�2 PARCEL 026.001 RECEIVED LOCATIONS OF STRUCTURES DEC 2 3 7.019 noWof `°`�R�G` a=��� No• \- '� g +� u\O avPNESE PENN FROM TO POINT UFF.CO.HEALTH 8ERVIC*5e e C STRUCTURE A B FFICE OF WASTEWATERB°PRo iGYr G\NP WEE o+ ta-� \ Ee I PSE \ 1r ST1 (HOUSE) 29.5' 20' \ ff G o °Ps 06 c` C3 ST2 (GARAGE) 54' 69' \ Q•,� A0 �- M��R i w �'�2�,, p� �9 0 gi CP 1 23' 34' N 6_ CP2 34' 53' NEo '% P ------------ 50 sGs WP�K�' � � �P ' \ 1 \ SANITARY SYSTEM LOCATIONS ARE FEN,N CID cP `l ""\O 9 ' AS PER INSTALLER. o51+ FE\4Olt! % --- ,� E 2 5��OVSE ---- ---------- Val - (S.C.D.H.S. REF. No.: R10-19-0048) M°N °ll'5E __' � -\r +; G F � j �\ r J,� t i `K W -` \ St` 0 ► , (§ �, C3 >. U"^l'TH�PtZEPALTERATIDNORADDRIONTO O \ 29 P \� - I %�. AST A o 'VC r i "BEARING A LICENSED LAND /� O+ \ Zsloo GPRp.G S N " �' �E ' O �� �' r S'j,I rLYDr,S SEAL IS A VIOLATION OF SECTION `Q\ OEC,K pP�(\O ; ' 0 q Cl ( ,,,� �In CA CA 7209 SUB-DIVISION 2,OF THE NEW YORK �L \ \ 5 •O+ w n �� 1 1 �� m FOt:ATION 16N ` ��.Qv, --' 5A(5 IClIES OF THIS SURVEY MAP NOT SEARING THE \ 0 \/'/\�� -_-- - GBPS \ L . SURVEYOR'S GREEN INKED SEAL OR EMBOSSED � S GL SPALL NOT BE CONSIDERED TO BEA VALID /� ESE° //'W VICE WE\y®EO �I (p ' iFjE COPY N\ GPSEFt MESER SER \ \\ PN° c� �r ft2 CERTIFICATIONS INDICATED HERON SIGNIFY THAT To M� Ni ER Pg THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE E='IS-NNG CODE OF PRAUTICE FOR LAND SURVEYS ACJ"'EO BY THE NEW YORK STATE ASSOCIATION OF o (p F111:1:SSIONAL LAND SURVEYORS SAID CERTIFICATIONS Sr' LL RUN ONLY TO THE PERSON FOR WHOM THE c� OVER° I�I \ (,� Ep°E SCTl`E1iSPREPAREDAND ONHIS BEHALF TOTHE �ss\ RB°R��SPEN / Of/ TGLF COVPANV,GOVERNMENTAL AGENCY AND LENDING S&SIZE ,� P Ih!ST I TU1101�l ISTED HEREON,AND TO THE ASSIGNEE'S \ O�i \ G/0 Q OF ThF Ui-t<D,^'G IP.STITUIION CERTIFIC4TIONS ARE NOT fo 6W �' ; �-/i /A:J TR4'\SFrR1,It"TOADDITIONAL INSTITUTIONS Ofl K \ // MAP OF PROPERTY F O R SDBSEQUENTOWNERS P ` f ( W �` ` � RN�O 0 A�e °SFR - ' ` -/ THOMAS BURKE & � 9 ° �\ 61 KATHLEEN BURKE 1J .c J o �\�NPL ANOS�9G ��\ m �SPGP\N ego K ,� = O��L SITUATE REVISED: DECEMBER 9, o 0 1N 0 SIT Y SYSTEM *0, g�Re MATTITUCK e a CES) 9. \ , SURVEYED: APRIL 9, , , �3,�p"� TOWN OF SOUTHOLD 69-x, SUFFOLK COUNTY, NEW YORK ROBERT A. SMITH, y o S. H. W. and S., LA ° tkf °RS P.C. ` AREA = 15,000 S.F. (0.344 ACRE) SQUIRES HOIJ)EN9 WEISENBACHER & SMITH LAND SURVEYING — LAND PLANNING — ENGINEERING I SCALE: 1" = 20' I SOUTHAMPTON — NEW YORK 15457 dwg B 857 P 108,109 STATEMENT THREE "C" ELECTRIC INC. RT. 1 BOX 45M SOUND AVE RIVERHEAD, N.Y. 11901 516-727-6618 Jan. 20, 1988 To Mr. & Mrs. T. Burke Date Re/Bray Ave Residence Bill as of 1-20-88 L INTEREST CHARGED ON PAST DUE ACCOUNTS Total Material $ 1039.53 Underwriters Certificate . 00 TOTAL $ 10 4. ------------------------------------- There will be a 2%credit service chargeon unpaid balance-24%Annual. SHIPPING As of the 25th of each month, all orders will be placed on u• hold until past due balance is paid. There will be'no returns on cut wire or special order items. All other returns are TICKET ����"� r1 subject to a 15% handling chargeat our discretion. Materials returned without our consent will not be accepted. No goods will be credited unless accompanied by the original invoice. Title of goods remain invendor until fully paid for in cash. Items not shipped complete have been back-ordered. All MEMBER 550 EAST MAIN STREET, RIVERHEAD, NEW YORK 11901 back-ordered items to follow. C ACCOUNT'NUMBER TYPE NASD f UNDED ° f0loam 1°0° 'S'' 1 t S 1+ CHARGE CASH H °•° ° f PAGE +OF i D E,,' r','a P CUST:bRDE F1;N 0., DELIVERED VIA' DWTEHIPPED CTNS. COILS aDLES. TOTAL PCS. TAX NUMBER FILLED BV CHECKED BV LN NDOR ITEM- UNIT PRICE M VE NO. NUMBER MANUFACTURER CATALOG NUMBER DESCRIPTION U AMOUNT R ° ° ° - r._t.-, t. + ` `tiv!, '/ t - 0+ , r _I - y-! .tt.+ - ,i• i�,• 'ry� �7v d� F, _ 7'J a t- F. 4 ^t„t t., P' ' :1�w!,r - Tt._.x--»...,....., v v^t"e': r,•.T".,-.. »-r;T..... .- y.,y-I".�... f rt., ^t:r 3 17 - °'Y c t ••�'�,t.” �' {rte' t t� •L rrx •.s' j s F /q �f l� :pl x•z;,...F,.,rx-^r:^,.,_,-,, �77 5 "_-re._.,...'. .-r_.�.-:r-"^ix-.T.-; :r•;,^.-'-y"'—�.-^ , "t"'_""""""". :";r•h_«,;"'" - - -- - :. .j i d- �A, ali :Kf w:. A.1 r fN y5! `i Y , :• a s.,• 5 I - TOTAL , I- .s 'RECE'LV ,aIN''G D,CONDITION'BY ORDER NUMBER ,0 1110, - SALES TAX •AUTHORIZED SIGNATURE, ENTERED BY \ TRANSPORTATION ® „ wr.}; PACKING SLIP LAIThere will be a 2%credit service charge on unpaid balance-24%Annual. SHIPPING As of the 25th of each month, all orders will be placed on � 0 eUM T U o hold until past pe balance is paid. There will to no returns TICKET w w n n M on cut wire ors special order items. All other returns are ELECTRICAL WPM, D�U 9 WC. subject to i 15°/D handling charge at our discretion. Materials returned without our consent will not be accepted. No goods will be credited unless accompanied by the original invoice. Title of goods remain invendor until fully paid for in cash. Items not shipped complete have been back-ordered. All MEMBER 550 EAST MAIN STREET, RIVERHEAD, NEW YORK 11901 back-ordered items to follow. ACCOUNT 110•NUMBER TYPE NAED .—1�•�\) .',! [ o � • FOUNDED • S `S •• CHARG CASH O H ••• - • PA E OF L 1 • D 1 l P T T . 1 O O DATE CUST ORDER NODELIVERE VIA DATE SHIPPED CTNS COILS SOLES. TOTAL PCS TAX NUMBER FILLED BY CHECKED BV, - ' -� � l � ,tMANUFACTURER-CATALOG NUMBER-DESCRIPTION PRICE ITEM NUMBER M • •.OAMOUNT C ••• • • • • t� NI f- ( uz. Zed' Rio m 1 Z' ` .. _ t\j Y• _ I i� P, 'I< .J4. M"; :,,..,. ;;; s I 71 py. zi< rt 'C Y, c4 , L 14l "tE b h a "t•t _ :rte.' t• -? - e., t .. TOTAL , X74 809 ORDER NUMBER .7-�_RECEIVE IN GOOD CONDITION BY SALES TAX NO, AUTHORIZED SIGNATURE ENTERED BY TRANSPORTATION 00- PACKING SLIP There will be a 2%credit service charge on unpaid balance-24%Annual. LAI SHIPPING D As of the 25th of each month,all orders will be placed on *911100 hold until past due balance is paid. There will be no returns / U HMNS O r1 on cut wire or special order items. All other returns are CWELECTRICALSUPIFTY, osubject to 15°/D handling charge at our discretion. Materials TICKET returned without our consent will not be accepted. No goods will be credited unless accompanied by the original invoice. Title of goods remain invendor until fully paid for in cash. Items not shipped complete have been back-ordered. All MEMBER 550 EAST MAIN STREET, RIVERHEAD, NEW YORK 11901 back-ordered items to follow. 'ACCOUNT NUMBER TYPE NAED - C�U CHARGE CASH ■ FOUNDED • I■0■ O I 1"1 ••■ � PAGE OF D P T T ; 11 O O DATE CUST.ORDER NO. DELIVERED VIA DATE SHIPPED CTNS COILS BDLES. TOTAL PCS TAX NUMBER FILLED BY CHECKED eY ii LN • ■ ■ r,i VENDOR• ■ ■ • AMOUNT ••• ■ ■ MANUFACTURER -CATALOG NUMBER- ESCRIPTIN UN'If PRICE U ■ f`M —''i'.ti:.l` tAj,•� int< "-5 � Y' J. t Y.... 5 � -iz r s, I, M '9 k r- �1i 'F -t 1" . 7456 TOTAL ► ,R IN GOO ONDITION BY ORDER NUMBER }I, SALES TAX oil- AUTHORIZED SIGNATURE ENTERED BY TRANSPORTATION PACKING SLIP - There will be a 2%credit service charge on unpaid balance-24%Annua � l. SHIPPING n As of the 25th of each month,all orders will be placed on � hold until past due balance is paid.There will be no returns w u on cut wire orspecial order items. All other returns are TICKET ELECTRICAL SMpp��g �HCo subject to 15% handling charge at our discretion. Materials returned without our consent will not be accepted. No goods will be credited unless accompanied by the original invoice. Title of goods remain invendor until fully paid for in cash. Items not shipped complete have been back-ordered. All MEMBER 550 EAST MAIN STREET, RIVERHEAD, NEW YORK 11901 back-ordered items to follow. ACCOUNT-NUMBER . T E /� NAED ( ""r" i1 ►7 `U D roUWDED loon PE S s HO •_ � CHAT CASH P - P T. ` ',h T .'' EMPLOYEE .J •O O — !5 ''DATE,' '=r' ,• COST.ORDER NO. DELIVERED VIA DATE SHIPPED CTNS. COILS BDLES. TOTAL PCS. TAX NUMBER FILLED BY CHECKED BY • • MANUFACTURER CATALOG NUMBER DESCRIPTION UNIT PRICE AMOUNT C VE NO. ITE 112R ORDEREDSHIPPED VNI • M•t'V.w;.»77 ..�- .w.x tv i a. o•s> s, : a .tix 'r'• e?�+X:w:z:raA`+^. ::r."i'. ..�'i`N%� ..w5.'3;»„;,.a: .... :tx<:;Yt.va':..:c.: ..,._s. ..<.>__. .•,_ .i i;,`'""'tfi. -,'t�;. R •-r- c-1 —^;'.t'..;"^ i:"'i. r.T ".i `°'ms .. -"-s^y^.-q"!7: tris _ :z- ;3. _,I.,„"i., a' ': ”§' -"t,'' - tis.,.r. ^�....,.- •-:��,,�!�",� .Y. ;.'s` �'Fs%y d-" P d.' hJ ` nax;• . , 'ys - "w:-n: t_ ?.. -r.r.:—t~-�":r M.;.>a.s`,_ K"'w'>t;.a.;?"r'.<...st^,...,.. Y,,, - �bi'.�.;".,.,qt, y.-T<'• .r...-,...s ..i... ,.v=l :sf k q:4r' it) Y p QQ .t<r f N ql^�», i• < s.Yx.'• 5 {yy 4 tin te. _ 'a 1., 'itl" iita. x., rl'.' vr- �Y✓"�<i+":".;§':- _...., - s 4:5i I_ M7 t(.. 3i G'• y.'!'. ':f't .3 -a? Yp. rl 2"tv "A v�y ala'• _ J;x:�:.• �r .s`�=� < -�r::�':.�;:r_<.,.._ ter>'-,. _ -c", s ��-,�::;» <Ta';ia��s�.`':s,_sA:fi:•:£>Fca. e.,.. 44;,.�:S u�;' . . ,�i .- .... .,-'�,_...-.. .:h '�-H, •", �».,., .,..,.-.,-�.. .» -'_._ .a,>.".v.«` >;,< t y � M k w�> mL,. A tri•ta:4-J a� rrt `r. a t } TOTAL DO- 371941 x, 7 `� 9 4 � ORDER NUMBER " RECEIVED^ GOOD CONDITION BY SALES TAX r •t I AUTHORIZED SIGNATURE ENTERED BY TRANSPORTATION , PACKING SLIP P .LAI- There will be a 2%credit service charge on unpaid balance-24%Annual D As of the 25th of each month,all orders will be placed on #Q'9b hold until past due balance is aid. There will be no returns on cut wire or special order items. All other'returns are subject to a 15%handling charge at our discretion. Materials TICKET ELECTRICAL SUPPLY., NQ returned without our consent will not be accepted. No goods will be credited unless accompanied by the original invoice. Title of goods remain invendor until fully paid for in cash. Items not shipped complete have been back-ordered. All MEMBER 550 EAST MAIN STREET, RIVERHEAD, NEW YORK 11901 back-ordered items to follow. ACCOUNT NUMBER TYPE NAED 73 • FOUNDEDuo• S ,. S •■ 011 H ••• • CHA GE CASH PAGE L D P b vll / O O � ,DAT COST.ORDER NO. DELIVERED VIA DATE SHIPPED CTNS. COILS BDLES. TOTAL PCS TAX NUMBER FILLED BY ICHECKFDBY di' ••• • • • • • • • • VENDOR •. ITEM NUMBER MANUFACTURER-CATALOG NUMBER- • . • • J,( W6 3 ir^t; Y'--'amu. yyt x^F r 1rt=:i_p - ti- I 5�, i� trt 4- : , r1ze= y1: ey rya 53 ;�, f ,. . v,. ...-,..o„,-., rce .—.r•�7°.^ c': '.' ..'._ _ .,.�,ibx'r; q 000 j. ,r a i sus'y �v f '1e r' 7, ,r l -Par ti•u.:L ' � :,-•::: _ .7' - 4 -z 0 s, � � �,A RIP TOTAL 00- 371940 RECEI' GOOD CON ITION B ORDER NUMBER SALES TAX 00- TRANSPORTATION TRANSPORTATION ,AUTHORIZED SIGNATURE ENTERED BY I PACKING SLIP , ;<y.. s: , = -µF: lj',`.; V - There will be a 2%credit service charge on unpaid balance-24%Annual. � SHIPPING o D As of the 25th of each month,all orders will be placed on � hold until past due balance is paid. There will be no returns ' w n n on cut wire or special order items. All other returns are TICKET ELECTRICAL W O D�LI Mo 9 WC subject to o c 1515% rl ng charge at our discretion. Materials returned without our consent will not be accepted. No goods will be credited unless accompanied by the original invoice. Title of goods remain invendor until fully paid for in cash. Items not shipped complete have been back-ordered. All MEMBER 550 EAST MAIN STREET, RIVERHEAD, NEW YORK 11901 back-ordered items to follow. ACCOUNT NUMBER T PE NAED ` 413 FOUNDW OS CHCASH PA L H WEi r' Tr T V' EMPLOYEE ARE/ �e O O T GUST.ORDER NO. DELIVERED VIA T TE SHIPPED CTNS. COILS SDLES. TOTAL PCS. TAX NUMBER FILLED BY CHECKED BV LN NAEQ • • • MANUFACTURER -CATALOG NUMBER -DESCRIPTION UNIT PRICE AMOUNT C ORDERED • VENDOR NO. ITEM NUMBER VNI M D }r' ..{-xsiv, xR•v..._ ,x>"•,.,. •;I."":.�-i^-*°^•=v -3'-^^5^^•.'-,;c ,^s-r�•»m Fa-m.w. b�' ,a.�,,;,r....,.s.-...., x,-••-„=--r -m*';L,�"::'--•sv r:.. ,�,p•.� ,`.^a;_^,,,.,,.... .zl—?..,.s.: '.::':^"Y e4,,,,, „r.,. ,S_., ,;,''su.. :F' ra-=w, ^'"�.•a k�"”" ;���� .,r?- „...r,., { , ee.fir h. .Y t' z= F`hr is (Jy�flq:/ - S';4 ..��-.^. .`` •�_.. yr"'�,'"I',i.a. ,s. a•�r -3,. *, �l t I F�. T% 4 `• jjj� Y .... , k t ..p.,,n._. —'7 < ...-_ �....:•�-�,,.. ....,.,..<.,..._.r,•:--r-.;....,....<—..•---:-x,...r..... ..,.,p:�.> ,......,...w..,w•.,._.t,T--_`». .ter••,....-«.;h:.'- - . �.. m. , i' f� C '•'ir, .. . _ ,.. . .uy.._ . .< _ .>....., _._ _.., _.''�" - -...- •:�' .i.' t ......r.,.^� � .�I=:... _., F s.f 4 ' L- h v lt'�N,. a�n^ °'•lea:. -�.5' b< } f'o f ZS J't i" 'f;G Pt _ �•�� %w r.of 3 - k 71 TOTAL ► I _RECEI� GOOD CONDITION BY 94 ° ORDER NUMBER SALES TAX *I' AUTHORIZED"SIGNATURE ENTERED BY „ TRANSPORTATION , I PACKING SLIP , s_; .,i✓� µ .> f ,._=.'^i There will be a 2%credit service chargeon unpaid balance-24%Annual. SHIPPINGAs of the 25th of each month, all orders will be placed on �• hold until past due balance is paid. There will be no returns ���� D / � on cut wire or special'order items. All"other returns are eiH r� subject to a 15% handling chargeat our discretion. Materials TICKET ��Lr���ll OLf�J�D returned without our cohsent will not be accepted. No goods , Lf LfV will be credited unless accompanied by the original invoice. Title of goods remain invendor until fullypaid for in cash. Items not shipped complete have been back-ordered. All MEMBER ' 550 EAST MAIN STREET, RIVERHEAD, NEW YORK 11901 back-ordered items to follow. -ACCOUNT'NUMBER TYPE WAED ~ Y • FOUNDED �Vi" I.0• • 1,`S ','' S •• CHARGE CASH 0 H •-• • PAGE OF: I,;ip'. E •/j'� CYST.ORDER NO DEUV D,VIA DA/ S IPPE CTNS. COILS BDLES: TOTAL PCS. TAX NUMBER FILLED BY CHECKED BY, cc VENDOR ITEM NUMBER M i N 0. MANUFA CTURER-CATALOG NUMBER-DESCRIPTI UNIT PRICE �C) ..Ta v n t _ :SSV' j5 1; r1 r ' ,- .5t 9'•Y k+ .kV t Y• .µ4V� �F�J :i .C,,,.. :5:" ^r_:i„ S;n -�-'r- ' i.,?a'.».,. .I..-. tom. w r,2 r _ tf� -b" n i- 4,0 I `i r 1 c t�x .la- :f' C• (AU6 r x1 t d� r' TOTAL , F1E> GO CONDITIO BY ORDER NUMBER SALES TAX , • i4.w TRANSPORTATION , ,",AU ORIZEDSIGNATURE ENTERED BY I t` n CE G SLIP There wllIbea2%credit service charge onunpaid balance-24%Annual. SHIPPING As of the 25th of each month,all orders will be placed on r u• hold until past due balance is paid.There will be no returns j on cut wire or special order items. All other returns are TICKET S*LIGHTING r, subject to a 15% handling chargeat our discretion. Materials returned without our consent will not be accepted. No goods diff �J will be credited unless accompanied by the original invoice. Title of goods remain invendor until fully paid for in cash. Items not shipped complete have been back-ordered. All MEMBER 550 EAST MAIN STREET, RIVERHEAD, NEW YORK 11901 back-ordered items to follow. ACCOUNT NUMBER TYPE NAED • FOUND[ loom ° ° `S S CHARGE CASH b � °•• • PAGE OF� L { I .o j. r-� C, o "TE !�f T.ORDER NO. DELIVERED VIA DA(tT I($/HIPPE/D CTNS. COILS BDLES, TOTAL PCS TAX NUMBER FILfLE B JCHECKEDBY] NAtD, NAED MANUFACTURER-CATALLOG NUMBER- DESCRIPTION UNIT PRICE U AMOUNT C ° ••• • r VE�NDOR NO. ITEM NUMBER M 3P C=o Vo 7 I j' .-.,.,i;;` '"<G_ - ,-z. _ ..i.+^«�,,,Y`',--•�.°'. - ,_,'.t'�-r,'.,,,.-»..g.- `"_`r',:>`..�, .�'_`'"«5--,....^e, .,5 F.,... - I:.,;^^,°-i,e'•^,- � vl f •x :'a^} ':; ds 1 i r` :.o S Y�"f c+�Y. S Yl S` t, v {^' f 1 A .S. 3 T' i v 1`�1Y`�,ie `i',�Tv�i;i�{'.': 1/J1 � :��t',;,^'�;„. !.•«. :'.....".. '`".�„".._,. . �,,,w"�'.�, '.(�lJ.• _ "-” �, I vr....;,,, 4 Y` fir{ is 8 '3TOTAL PON.6 !, "RECEIV N OOD CONDITION BY ORDER NUMBER `\ SALES`TAX 011- TRANSPORTATION TRANSPORTATION , `� +' AUTHORIZED SIGNATURE ENTERED BY W 4, q"rrot eo. lose. P.O.BOX 326,MATTITUCK,N.Y.11952 (516)734-7171 -734-7172 Oct. 21 , 1987 Tom Burke 1925 Bay Ave. Mattituck, New York 11952 SITE: SAME -AS ABOVE. INSULATION AS PER QUOTATION: 13 PARTIAL BILLING 0 COMPLETE BILLING INSULATION: OCT. 8th,' 1987 Ceiling R-19 instead of R-13 quote Additional $65.00 from quote. Total Labor and Materials $580 .00 Five hundred eighty dollars----------------- ' Thank ollars----------------- Thank you. COMMENT ON THIS JOB IS INVITED ONSUMERAFFAIRS % T 4UF dLK 232111 T HNASSAU-011900190000 �41;011_V A 95 w R, zq fs F 11111.11.0305 HOME INSULAT-166 325, MATTITU 5 A RO BOX CKi N1 (516).734-7171 7344172 Date: _'S,ept. 21 , 1981 Tom Burke TO Contract No. [Herein after Called The Owner) ADDRESS 1925 Bay.'AVe.- 286-8-&68 Work Phone Na. CITY, Ma-ttituck . 11952 New. York State z SITE: ' -5th-, and Bray Ave-. - Mattitudk [J'Roofing; []Sid'Ing 13 Insulation I n s'U-1 a t-i,oft: Ceilings with- 3 -3/471l- 13 $1-75.- 00 Ziftbrior :w-a:11s with 31-2 11R-11 $"; Interib`r Walls, with 81-2 1IR711 50-00 Q.'a:'iage ceiling floor.) % 11with 611R-19, 00 Total Labor-- and- Materials; $515.00 Five hundr6 d fifteen dollar �"" _ ----- -------------- - Thank you. TERMS QF-PAYMENT $ the work. '"Balance' zOpbn b6mpletion of FIBER GLASShome insulation-is made of ageless fibers of glass thatwill,not settle, are-incombustible, extremely lightweight, permanent and provide,no sustenance for vermin or rodents. The Contractor shall not be responsfbie'for d-amag or-dela due,to strikes, fires; n I ts,-or.othe-rrcauses beyond his _ _: .!e� - Y .I - � reasonable-control.-The Contractor carries Workmen,s-Compensati?�:aq,d- blic Li011iX Insurance, but-does not assume r S' isk of-anyoth6r-characterunder this contract. ACCEPTED- BYL Salesman Approved— Owner- Date. Title A 9', N t� 'Xil�P'�jW -9T AK, 0 q V Y- �— 1 —, .&�JgA Aff.qV' X- 2 Ze _g Z; W,E. Via., 44OB-k-SUMMA �t I I A 44& fi Q� "'f N "2:s- 'WIN GIRM RAW BIN 41" D�Yia� '7-ew 'ATE, 11 P-'3� Al— _jj I 4� rte_ f TERA ltq EX7-T ZY 777. -2 87,fR'.,10 2. 4L, Vt. 77 77v= '77 5– ,I DWI ,.6 nVEZ i�"'e,' tj:j-= Nz -4",117 KAX L�4� Yi- "I IV, A-- Q, 111 5 '7' -T z; 91 4 NT-pv T"C-4 4 :-,,x vis It zZ11--l�-11c1 -v1-1-l'-'�'q V! V12 E 1:111F OU":! 51- W-i; Z vawn'-1 A -F�75� ------- ip—77777�77-17;�- t7? 7,77,7T s,�77777-—7, 7,77 T- 77777477-7— zt- —S ^A 2-4�'tll jz-ay '0?"r an in Ri Al 4 77 ........... t. 77,77;"T 7, iv-Z w'm -u - b di- -ln' v- p: y; J, ZT1-- L n TL "A0 -z _ mdaa..',Y"; _ 'a"£r. .w'c:a''.x'-„ •;'s"=`::r-. a.c� "_� :_�_x,.� ,�--. _ _ :,;=:s, z'-_�-_ .'�.£'^ s”'= .�2__ _ _'_`�.':.:- ✓.._: _ _ -,� -�3`,- ate.'e - - __'"t,, >•'2>i� _ .-�Tw'..z i"";.3"��„'.::^v'_4c - _.•�_ _ -_ =-E�:^ For Y - our Plumbing & Heating Needs Call �1 298-8393 MATTITUCK PLUMBING SUPPLY, INC. WELL, OIL BURNER & SHEET METAL SUPPLIES f PIPE CUT TO SKETCH MAIN,ROAD P. 0. BOX 1429 MATTITUCK, N.Y. 11952 Cust. Order No. Date J jr 19 _ _ e Sold To .) (-1 8,444 Address SOLD BY CASH COD CHAR ON ACCT MDSE RETD PAID OUT _C QUANTITY DESCRIPTION PRICE AMOUNT J ~ Z) L b I 0c) tj 'I 1 ©� 1� fs At ,I $ OCA ALL claims and returned goods MUST be accompanied by bill. TAX Q{�� Recd by I..1 4 7 31 TOTAL lab ,.......c. 57997-94 _ '1.`•'„'—�:�����-'�="j�"?n,it•,��f._>i:'I";` -a�„=`f _y_i',ti':;��:� t STATEMENT -'- --- - - `m.-mfr - ___ •.0 -” - _ -_ - moi.:.-=�� � ' 516 298-8393 MATTITUCK PLUMBING & HEATING CORP. CONTRACT7JYG-SUPPLIES-SERVICE - ` P.O.Box 1429 MATTITUCK, N. Y. 11952 -7_ Om L J A SERVICE CHARGE OF 2%PER MONTH ON ALL PAST DUE BALANCES. INVOICE CHARGES AND CREDITS DATE DESCRIPTION BALANCE • NO DEBIT CREDIT BALANCE FORWARD C i� fy 1 PLEASE PAY LAST PLEASE DISREGARD NOTICE IF PAID AMOUNT IN ` THIS COLUMN MATTITUCK PLUMBING & HEATING CORP. Z Z- P T" _2 W lk- 4f" W_ N,, rV R, % -4 R v MA W;J x& I LY;Fz' OW- i-. T g, -7 E-ATIN"Mi :MRM�I�,;-",- 'Y'g, smW&W.liu PLUMBING- ff Z7 4-1 Q-54 fW,7-,-2-9818393'� PH6 6�,,,, -, ain..., oa 7 -1 177 71r 17r ".1 AN SNotAob'�rL ., 'T i vv P tj ;2 Id e a t i 6 h ZZ- .-MATEMAII-I DESOR 1kTIaNq�t�p I - r'CTEX d U 4, __s Wit.or E� Cae n u %.ov I_11_n5l 41 tt 3� 6�_4_ R -J)Lt�j!Z, M V- RY -1-x all A 'J"; V6 k S v zz ai a j -q p 410 77 - ,�Yzm, V, 'Iz'I Ac_ �;p .v k A) Is -A 7777__7% 'S N 4i _7 �7 JR, &Ai'='�v _S7 'r -41 5�Q ;,j -'LL'F'.^'✓.'CF� _ _'-=-ai:QwTiei;.'.a%.'�'--�-:-�-..:rta�-�c "`-_ems 1'':Y'-i-:�s's2',�rc ^�n'�I rs..-^.'_�_.-T�x`t _,-v-_=-';_;a�_;�a-,_T.^s;i.—_ '....._ntT'-`.rt-'--' - _ - -- - - ,61..:, - - - _`G:• - - -_ iY a>� .;'�is.5� Y`r9.r'�.!_rx - - '>4�l" - __-- -_ - �1 - - - - - - -�-_ _ -_`-tC'.�-�_-. _ _••�-]'...`_`-�'_ ~Cit._-"� _ -- - _ - - r STATEMENT I _ - - GAS ATONAL PROPANECORPORATION v DATE- TO. ATE -- i :_.DETACH AND RETURN•UPPER PORTION WITH YOUR REMITTANCE $ 1 I :Ile 1W 0 t v "Aw P# 1 _F YOUR CHECK IS YOUR RECEIPT NATIONALPROPANE CORPORATION ' 215 6A MATERIAL iSWE FROM: TO: DISTRICT DISTRICT ✓r�r� Date DESCRIPTION QUANTITY I APPLIANCE No. �'t w• �N�'i� _.�- „tb,'-, it `1,3 I"��s((' a�f•"�f G t.b! 011 a,43�,�•iy`'„t'`w1Y..,- �r" - '„'�-ify,'. r - �„ --� '�' -t: � _ �'• a __ "" - {..{'i�`�,fh•a��Sth4 r`sir'? ^� , Received , Signed' by Customer ;,;v ;,4,:•;n, r;. `4 for Issuing Office INVENTORY CONTROL COPY Z'7 7, ciNSTAI_ _'CONST "A ON -CDR -OF"NATIO 3! -:PROPANE�. SERVICE A -W�0 4,1-- 4" E DISTRICTPREPARED BY, 4TPPk6ED' D'Al NAME "ACCT.'NO. ALA [F1 ITIAU ADDRESS- = A CHARGE —ZIP—TEL. NO. -CREDIT OK TENANT LOCATION (Directions), IND.' -T-LO N I KS T F(U-10- INSTALL EQUIPMENT: "TYPE TANK SIZE EST. FEET TUBING NEW LOCATE AT ADD-ON Cl P (DRAW SKETCH ON REVERSE SIDE) INSTALL APPLIANCE:, TYPE MODEL No. _2 REPLACEMENT ❑ MANUFACTURER UP OLD APPLIANCE I SERVICE REQUEST ; te AV ?710' O-A/:7tD 1*;q7 COLLECT E- APPROVED BY. f'COAD:E • DATE-PROMISEb rT .REPO -Woq�--Of7`1 k7 aw_ Z _- -EQUIPMENT METER No-EL, READING V U LATOR' DEL No,. HOOD AND BASE, -PIGTAILS PIj1?E/-rUEf1k SIZE _'FEET APPLIANCE AN STALLED: .'MODEL No. SERIAL No. .,-APPLIANCES CONN ECTED:",RAN GE- 0 W. DRYER HEATER OTHER:' MANOMETER TEST: OPERATING PRESSURE I LEAK TEST: PRESSURE— MINUTES SERVI E PERFORMED: V 0 DATE TIME FRGS TO HOURS MIN. RECALL TIME--FROM TO HOURS MIN. Quantity Part or Model No. Description Price Total-Service Charges LABOR_�# PARTS TAX TOTAL The use and care of the-appliances,and equipment have been explained. Work has been completed to my satisfaction. RECEIVED $ RFrFIPT No. CUSTOMtz, ,,_ SERVICEMAN CUSTOMER COPY FORM 310 IDENTIAL O N 1985 GAS APPLIANCE SYSTEM CHECK #5610 r" ��9 Gag CFEIX Cv4a C1fIX __- �- !J Account Number T.M. Company/Location Call Date ✓ Name ��/�%�"L`` Date Requested Call Taker Address Name t'1 7:6= Instructions: 'Telephone: Office t-� f" ?ter Home ` ' Performance Check: Item Central Heating 1 Space Heater 2 Water-Heater 3 Range 4 Clothes Dryer 5 6 7 *Manufacturer Model No. r � �'1,6- ^'= Serial No. 2f® _ Fuel BTU 000 j, 000 j 000 NIA NIA 000 000 Age Y" J MAnual Shutoff (Installed/Existing) Sediment Trap (installed/Existing) y Control MfgrlModel No. ` Pilot(s) j- Ignition System(s) MfgrlModel No. Thermostat(s) MfgrlModel No. Ri Pilot Safety System / Burner(s) r Combustion Chamber ; NIA NIA Filters f NIA NIA MatorlBlowerlPump - - - _ NIA -NIA- Sufficient Return Air NIA NIA NIA Draft Diverter ! , Venting Combustion Air Red Tag,.(Removed from Service) TANKICYLINDER(Add'[Serial #'s): SIZE SEflIAL NUMBER MFR .MFR GATE-� LAST LOCA- TANK PAINT PIGTAIL FITTINGS GAUGE RELIEF VAWE FITTINGS _ �,_ TEST DATE TION CONO COND Co'. CONO COND COND DATE CAP LEAK TEST PIPINGIREGULATOR OPEBATIONICONOITION PIPING REGULATOR REGULATOR MFR MODEL REG VENT W FLOW LOCK UP SINGLE DATE CODE CONDITION POSITION PROTECTED PRESSURE PRESSURE STAGE A;-, �. - !;_ d IN WC IN.WC TWO 1ST PSIG PSIG STAGE 2ND IN WC IN.WC SYSTEM LEAK TEST SINGLE START PRESSURE END PRESSURE TIME HELD SYSTEM OK Comments: STAGE (INCHES W C I (INCHES WC) I /J (PSIGI (PSIGI ^ TWO 1ST STAGE 2ND (INCHES WCI (INCHES WN This inspection covers(propane/LP-gas)items and equipment visible and accessible to the service + technician and represents the conditions existing on the date of inspection.It does not cover latent,or manufacturing defects,the internal working of sealed equipment,or structural components,and cannot Reference Invoice No. �f Date be const to cover future defects or unforeseen happenings ', (Mo,Day,Yr) _ 1 � 7) (Please Print) (Please Print) • Know how to turn off gas in case of emergency. Certify that I have comple ed the System Check as prescribed. • Have smelled propane and can detect its odor. Performed odor Test Performed Pressure Test • Have received the Consumer Safety information and material. • Had gas system deficiencies and/or corrections, if any, clearly explained to me. Placed Safety Decal ❑ Yes Left Consumer Safety Info ❑ yes and material •Am satisfied—withservice work perfofined. /01 �> ., Customer's Signature - Service Technician's Signature CUSTOMER COPY tea:,'"`_"""�'�. - - �.�•�_=�-- -_��d:�':_., - _ - _ - - -- '- _ - _ - _ -_ - _-_ - N�S�i SHOWROOMS-"- ` 4. V11yei�dench. ?3 s"3s ;js: -'Y•i:' `3�f: .iy� r. tc. ? i+> <y; .. .- _ _'_ - .Sr'..t'. �R.=k-:t3, e�.`Y•1"i.{�:.v�f `i_ 'l: +''`e•:a' .� ,F: `$�• s'�J i -New Hyde:Patk tx` - .(A,- _ .r• y. 9, �:i`. _ _ r =e`d-�,:ia:_i: ^,• b'i�:}:'�>:. h:, :`{�.;ia3.9' 'Ir�':7i int`.�:7.':3'^ ::*'•n U:i?";'?r:_ �: - :Riverhead:L"1,N.Y.'-, - - la�ce:lionkonkoma:lL.l:4N.Y._ �. _ CONSERVATIVE, i lFv4}3'.:-I:z_i.:. .,;t,•:{•, - _,, _ _ _ _ •>;�;ns:: f'�.�:�A ;DLYISIONaAF,�NAT.IONAL::rPROPANE:CORP,ORATIO_Nw^ i-` - _- -�- - - _ TWYANDA_NCIE;=N:Y:-f'-f•798_.>� ,4 Acct_�No: - District --' 17 == :r .t.-_ = ya« _ _ -3?r:3;`�-�si_S=? - - �-''•- - -. -- - -' - ter:= - , - _-:,t'_ '_ - ',�, _ '�-3, :: .- -.._ ,,- _ .J' - `'"-,. :E:6 r'-`<:.'r..T�_ ,,., .3'i-'i• ° _ _ _ _ _ _ _ -f_ - - �. _=Date--�____--•_-__-_____-,:_--____-- pr_e entativ _ ' u - _.Conserva.twe,'~^ 'Gas' =:A I�catron= 'Bulk:Service` �T_heF ,undersigned ,(herei'nafter called the request Conservati �rGas Di i :Natio ial - s ci a Propane.CoFpoKotioii`''=to furnish"and='m`stall';-a=^Conservative G'as System at ___ __ === til _= : _ �,- Phls(caC.Locotiort). y------— -?U =- : .r ---==_ '= %--- -_=--------------- ------ -= - = (heidib "€a�lid`•-the-"-','-"rmises'.`- ond:to=scrp-ly-_ga's-for.the:premises;+all,_subjec#_,'to.-the terms:and,conditions=sets far iY-orr-4h-:reverseY,sidexh�erebfr ' - P k w This=re`uestiis'nom a`nceTlafile`for o peciodtof tl i�ty;day`s::orid shall'become-a�contiract.eithef-b• .-the:--erf6`rmance of the=request�for;the.making of the itlstalAl'atio'n or._byJr�heY,written.;acceptance.he'rEof,by..an'executive-,officer'of =Ngtiona4 ProPone_,Coipor-ation (hereinafter called' #he.`"Corporation':). = =THE''PROVISIONS _r THE'L KFVERSE=-`HEREOF RE AN INTEGRAL'-,:PART_-�OF T ,IS`'APPLICATION' ni_5'�r w,% its ':.�•'r. - _ �•.b.^ :h,rt eft �. _ _ _ _ , - „ - Subscriber (HusainY�id`) - - --: ;=;�,^z7 _�:,�:.c:.;r,k`- Win:"=_ - �(P__rint)�.- _ -. :�5°` _I�` .-' -- .- ,a�''.,'<Y. �'4:- =r:. - - _ JlPrint)•--, -7-- -_ _ a4t ;•-' <• iw `=dr-;alk _3c{=w•a' -. - SI n4tUre , � ;y'ry'-r.: - - ^ra^^•,f-„z�;�i?e"Y..+a�'� _ _- :.t - - - - - -- ..•� - - - -- - - .'T - _- mac_ _ _- _ _ •�'F�'-�s..."-z:�'- - - - ' Mm murn-Purchase of a x a ll'ons'perannum-requited: : _ - r - "' �Custo er m -t -be billed-for,difference,lietweei,amount- �,. urchased amJ"the:rimini • i =tP mumron_an,annuatsbasis at the- _..:prevailing rates.;, = -' `LNoilin Address`'at 'Installation' . _3.n7 :.1 _ _,. - :__'; :;__ _:,r'_• :, _ lT+- _ oc`Street 3 C=NiTowny _ --------------- :State ": f" ?hone y' s Permanent Mailing Address --- --------- ---------- ----- ------------------ ------ -- - 'Baii`ar'street -" own' `SfBta'v '' Phone Property Owners Nome' ;,_' v --- ------- ----------------------- ---- -- ---- -- -- - _ - - ^ ' •Property Owner's?Mailing Addles"s __=-__--__:__=_=_=-___ ______ _ '-Box or'Street' -"" - "Town" - = State Required SECURITY `� 's- -Cash- Deposit''Rece,ived $�_____=___i_____ =Date"_' ___ _____.____'_ ______=Nation'al`'ProPane'CorPorationf ' „ !. Other Charges 'j ' ________________ •_ - `Cash with-Application Balance=Pay`dble _ y'�Casfi'on`insfall_ation _=__ ______ _ _ 4 D"ef_eere_d" . - - Cash:Received''on otki`er'charges;,$_--_-______ _ Date^___ ________ ---------------- Notion o one,C oration - - - -- . Y==-- - --- - - --- ----- --- -- - - - - - ^•lei+.c•i' .4 'p•?t:`-�; - - _�~ tom`,",:-.• _ _ ,. __ _ _ - - _ = APPLIANCE NEVIF._ UPANCY' Range . 'r F ,, =.:"-.r: =___ _ s v:- Domestic'" = = ' Ye6r'Rou'riiJ' Woter•Heater_ z, _ - _ = - Commercial, _ - -•Seasonal Corit.' =Dryer_' ='_,..ti-:.;: _, - = I'ndustriol`" - -_. -later_ , w Cher ;__ institutionaC` - ` CUSTODOWS COPY • RETAIL INSTALLMENT CONTRACT ti CONSERVATIVE GAS Drvision of National-Propane Corporation 18th Street & Merritt Ave. + Wyandanch, N.Y. 11798= 19 3, National'. Prop CorporatiM (sometindd her+eimatter refereed.to as "Seller"), hereby sells,;and �l1 ( W Name(a) of P%r ser s (Please ` (Street and Na) (Town) (State) the undersigned Purchaser or Purchasers, Jointly acid severally, hereby purchase(s), subject to the terms and-rotf�itioni set forth . an the reverse side hereof, the following preperty': - 1 QUANTITY 13JE IPTTON SiODEL O ,`y,BLRt�, NO. D✓ which property is to be delivered lit the Seller to a Purchaser(c) at (Street and No.). - (Town) For the priee,;cafj olrted as follows: 77 (1) Cash t Priee�;the above,property �� d •- (3) Cash Ssiie�Pike,,of,Inst idlation- Charges (d) Total Cash Sale Price A144,0 I .?!l C�•? (6) imm Qowa :aayment: (a)- Trade-in Allowance of— Make Model $ (b) Caah ,( Too Down Payment (6) Deterred and Principal Balance (Item 4 minas Item F) _ S•�� (7) Credit Service Clarge $ (8) Time Balance_ (Sum of Items 6 and 7) (9), Time Price (Sum of Items 5 and,8) 7 Beginnin�_z �� ,the Purchaser(s) will pal the Seller the raid Time Balance in equal monthly installments of E each and one (1) final unequal' installment of I - until fully paid. ,All payments b3 the.Purchasec(s) to the Seller shall be payable to Conservative Gas and shall be made-at or mailed to: ' TIIRCH ASER HEREBY ACKNOWLEDGES RECEIPT OF AN EXECUTED COPY'OF-THIS AGREEMENT APPROVED: Credit-Department, Conservative _Gas Division RETAIL INST LLMENT CONTRACT i ( urchaser — Husband) Contract Na - - - - - WITNESS: (Purchaser — Wife) NOTICE TO F iURC A_SERQO _ L Do not sign this agreement before you read it or U it contains any blank space. L ' Yon are entitled to a completely filled in copy of this agreement. S. Under the law, you hairs the right to = y g pay off is advance the fell amount dee and ander certain conditions b ohtsi�a' a partial refund of the credit service chart& 5+ ="�w-is--�-r; r_Y._:^x - -r vs c-'x_�;•' - _.'t".r�" .,,i'`- - " -zR - - __ _ _ --_.7._;x6:'✓` :tit'-., _ _ _ _ ''.'.;'�;; ___'`."-'__ _ _ _ _ - - - - -" -"'V'-...•_ _. r'".� -_ Y-Ir 4%167 _ __ _ -" _ � _ —_ __ _ _ - 1 .a ___.. - i . _._ - __ _ _ "-""5'-l'�F°^S�o^.-w.C,•.vi'irh: .=�..rT?u^ss, �l ,• -nd Cfe`Z__9_L.��6:?."1T•-�w„K�a"L'.,_'..-.y^P- _ 1C7fC�Gtz1ELifr .-x,:. GARY ME R IXA�T MERRIMA-N ROCKING 290 MTlabasso St• Southold, N.Y. 1.971 (;.,6)_76574338-. - -_ STATEMENT Tom Bzr'_�e ' 4th st® No Y. r s L.00.00 c, -PLEASE RETURN THIS STUB WITH YOUR REMITTANCE.YOUR CANCELLED CH_ECICV YOUR RECEIPT. 1DESCRIPTION • Y 1 I?/�Jt/8 Spackl eino appartme ' 400.0 -o_ - PAY LAST AMOUNT IN BALANCE COLUMN A 8S 874 carbonless POLY PAK'(50,SETS)8P874 '�• ` �_-� - - _ - - � -7777— � - - -�----�---=-- 1 F- , !#-=L .`J, RIVRHEA,D, 'HAMPTON BAYS' 'PI'CK CASH,-, RIVERNEAU ' "r�Zi t,tAgTHQMPTON,,f O;RUL SKI ,f i QUOTE 0`COD'y 3 r �' •'`{'e•"f-S.'1 Z'}• ..� s ,'�� f'rl '1',+':fi:3' e.r,� ., I OpP >=D'yGRE NP,ORT ,,SOU�,HA :i' MPT,ON'' ) BUILDING, SUPPLY CORP. I�'II E '' iwiE I N !T I'', i !.".T I 'F' r' 1 "7CI E:: `'' t VEL' .: r':(:')P",- _r't SOLD TO:TO: F.a_"-`�;�; �181t.if l� r �,` : SHIP TO: i 1, wl �" I f�;ti.`F , !,_► c i ';C 1,.,. a CUSTOMER NO RBS PO NO CHECK NO INVOICE DATE INVOICE NO fir,}.. & r"M()00 'ORDER TAKEN BY- CUSTOMER PO NO CONTRACT NO ORDER DATE ORDER NO I�'i'�,'r'<:i'i, •',t,kri�y7�+.jal•'•S f�l.f. ,�.:id31 7^'r fl � ;:t�rf,i�i:i 1,.����".f F '-JOB NAME: SHIPPED VIA TERMS % L Xt>MIl';!';1'. ,.i T:ll�: 14'r>i;1;:F P8t`'t€�{l'•1��`^'�;;",t •�\' H t,�z;E`rv;`' •>�M. :ORbERED� „�s: 'SHiPPED� ca,U/-M_r `.iY"� .�x-.+''ITE�u1°NUMBER",.. DESCRIPTIO . . CEt. AMOUN' ^� r?NVT:• i -I<��L i:�01F' DEL. {A'. tl.�l.rl . } g'i�. I`" '4 IS.T�..)r"r'I'1r'Ii,1- 1;�.;~•;��; �,r" ,r ,. �1 ,'+.w' ,�:�1�^:� . 1-'.I":o:.A��'!F',h iq'':�^-•F'',e::1,Ip�:;.. i -- E i �� r_ ,+1 ��^^ •� jj r � M`s S •F.'i^`' {"1 :, 14 S �l J�+ Ji: i. t' r+,' i' ii.� r %•.1,�:J"i , -� '� �...1- fY�,« �'"i !1"h.'�".. ! .>-�641..;9° 4'�+ ,•7t t 4freygh,z,.. `'i i7 {y^1,x.� 'y F,c !,, r. r' ,i ftp 1y"M�'•r,,,.; IGH 8 Fw:;r;,{,�:. '��t�: ✓4,rur.F-. ,sa 'r =fr,:,;'i;:,:},« w1s-:i'..i y.y;i',��.:'-�rtx,r.,��gc;"',F,E� -- _':'rtt;'",}'�':`-ir`'1:si _ SAL"ES`TA' ' • FLFS, RECEIVED ITEMS BELOW IN GOOD CONDITION m SSE TERMS AND CONDITIONS ON REVERSE SIDE HAZARD MATERIAL EMERGENCY CALL 516-727-1553. All other calls,use numbers on back. A'•LATE CHARGE OF 1 1/2% PER MONTH" 1 r(THE CORRESPONDING ANNUAL PERCENTAGE RATE IS 18/0) AUTHORIZED SIGNATURE ";L,.11�'; Will:be charged on unpaid balances over 25 days old OUSTOMER k^fi,,r'>V:'h-.ty, - '•tt�'' a ice—. - .--- _, r .__. -,_----� ,_._— °�—�---_—. � � , JOB No. 15457 N A13049 SUFFOLK COUNTY TAX MAP 16.35' 1.6 10.0 DISTRICT 1000 SECTION 126.00 BLOCK 07.00 VENT PARCEL 026.001 BASE HEATER r TR SS PLAGARDING REQUIPM HOT W TER �D TANK N cD 0 co _z UTILITY ROOM APP O ED S TED JJDAT / • �� 0 1 Ita-, �, � X FEE: ® BY: NOTIFY BUILDING DEPARTMENT AT wWASHER DRYER 765-1802 , 8 AM TO 4 PM FOR THE FOLLOWING•INSPECTIONS: o r, GARAGE 1. FOUNDATION - TVO REQUIRED OM ��� 0 o FOR POURED-CONCRETE GATE o N a`� q�® OSET 00 N 2. ROUGH - FRAMING PLUMBING 3. INSULATION agfyo01555' 4. FINAL -`CONSTRUCTION MUST BE.COMRLETE FOR C'-O_- �Uli�j �: -lFiCATION ALL CONSTRUCTION SHALL l3R �IEEi THE ; �1,�=�4U CONTENT BEFORE REQUIREMENTS OF THE CODES OF NEW • YORK STATE. NOT RESPONSIBLE FOR w CFeR T I{=[CATE OF QCCII P/��C DESIGN OR CONSTRUCTION ERRORS. WATER cn 26 73' U a Stipp, y SYSTEM CANNOT EXCEED 2/10 OF 1% LEA®o CCOMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF GARAGE DOOR GARAGE DOOR �li���SOUTHOLDTOWNZBA ' TO rSOUTH;OLD 2.00".00' OS 2.00 8.00' � .00' 9N.Y.S.WOOD 2s.00' 01 � LANDING Pq03.60' X 3.83' SMOKE DETECTORo N-P+�idld�d6--S9 3cY co CO DETECTOR ' W GARAGE FIRST FLOOR OCAY O FLOOR PLANS OF GARAGE Additional SCALE: 1/4" = 1' P FOR o o� Certification USE. � UNLAWFUL WITHOUT CERTIFICATE THOMAS BURKE & PREPAREDOA �� M��T Be Required. 2020 CCPAY KATHLEEN BURKE NOTES: 1. APARTMENT WAS CONSTRUCTED IN 1988 AND CONFORMS TO SITUATE EDWARD ARMUS, P.E. 54106 i NY STATE BUILDING CODES AT THAT TIME. MATTITUCK S. H. W. and S., LAND SURVEYORS P.C. SQUIRES, HOLDEN, WEISENBACHER & SMITH RETAIN STORM WATER RUNOFF PLUMBING TOWN OF SOUTHOLD PURSUANT TO CHAPTER 236 ALL PLUMBING WASTE SUFFOLK COUNTY, NEW YORK LAND SURVEYING N LAND PLANNING N ENGINEERING '✓ OF THE TOWN CODE. &WATER-LINES NEED SOUTHAMPTON N NEW YORK TESTING BEFORE COVERING 15457RSP.dwg B 857 P 108,109 i 1 OF 2 !� I t 6.67' 2.42' 18.91' IF / 1 SUFFOLK COUNTY TAX MAP --C7"-70—OF OVERHANG DISTRICT 1000 SECTION 126.00 BLOCK 07.00 Fol PARCEL 026.001 06 w ri Q STO VE REFRIG. O _ � U � I DINING ROOM KITCHEN 0-0: BATH 4 �x17 (V U� � w O� 0 DD O r- 0 O Lo O N O 6j N GATE N LIVING ROOM BEDROOM cn o OU o U cr) w z o Q r7 0_' 2.09' 12.00' 2.08' 7' ROOF OVERHAND 50 .00' .00' 4.001 50' O� vv 28.00' �0SO SMOKE DETECTOR CO DETECTOR fe FLOOR PLANS OF GARAGE GARAGE SECOND FLOOR � SCALE: 1/4" = 1' FOR �� o ,06 �� THOMAS BURKE & PREPA •09OFESS�� & 020 KATHLEEN BURKE NOTES: 1. APARTMENT WAS CONSTRUCTED IN 1988 AND CONFORMS TO SITUATE EDWARD ARMUS, P.E. 84106 NY STATE BUILDING CODES AT THAT TIME. MATTITUCK S. H. W. and S., LAND SURVEYORS P.C. SQUIRES, HOLDEN, WEISENBACHER & SMITH TOWN OF SOUTHOLD LAND SURVEYING N LAND PLANNING N ENGINEERING SOUTHAMPTON N NEW YORK SUFFOLK COUNTY, NEW YORK I , 15457RSP.dwg B 857 P 108,109 2 OF 2