HomeMy WebLinkAbout11561-z FORM NO.4
TONIN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Ce1t&zte Of occupancy
No. �!AIQ5. . . . . . . . . . Date . . . . . . . .Augast. 2 . . . . . . . . . . . . . .. 19 .82
THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Location of Property%. .944.o. . . . . . . . . . . . .G410. .4P*jr. .��PA . . . . . . . . . . .CutrAu p. . . .
oum ftwet
County Tax Map No. 1000 Section . 05. . . . . . .Block . OA . . . . . . . . . . .L,ot . . .Q 15,AQ3. . . . . .
Subdivision . View Gg tater, , , , , . ,Filed Map No. AR41. . .Lot No. . l 3. . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.F e b r u a r Y. 1.l . . . . . . . . 19 82 pursuant to which Building Permit No. .115 0 1. .T. . . . . . . . . . . .
dated . . . . . February, , 18, , , , , , , , , , 19 ?. ,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 . . . . . . . . .
a. P.riyate , one-tt'PtuA�Y. aweP1 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . . . . . . §taller„Associates
foabiw NsiiiiisiMir'tj
of the aforesaid building.
Suffolk County Department of Health Approval
UNDERWRITERS CERTIFICATE NO. . . . Pendipq . . . . . . . . . . . . . . . _ , . . , . . . , . . . . . , ,
Building Inspector
Rev.1/91
FORM NO: 8 '
TOWN OF SOUTHOLCO
BUILDING DEPARTMSNTIlk
'
"TOWN HALL <
SOUTH'QLD, N, Y
� f £
4
BUILDING 'PERMIT
(THIS PERMIT MUST BE KEPT ON,TH.EeFREMISE,S UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
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N° 1;1561 Z Date 19...
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Permission';is hereby granted to:/
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to ...... 4A+f7 5�L 6 4 .....)/ /�."... *'2,��R/��e y� �y�L 1, 1
.G . `.�............41...... .x.°. .'�..•.../" k: ��.`. .� 'fwf 4 :f, ... ..... ................
,
at premises located at ...�..:?"............... .
........................................................................ .."t ..j1 ..... eqs Wf/:Yu 4+f .. .1W•..t/�`
wh- P r
Y
County, Tai Map No. 1000 Section :. ,r.TM` ...... Block ,... T....,... 1Lot No. t lel.-.. ......
pursuant Yo: application dated .. ..., <! .,.,." c..... 19...: and approved by the
Building Inspector. " s
47
Fee $. ...........
I'
Budding Inspector
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Rev.!6/30/80
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FORM NO.6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal—(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date
New Building . . . . . . . . . . . . . Old or Pre-existing Building(X) . _. .__.- _ s 'Vacant Land . . . . . . . . . . . .
Location of Property . .•. . Ay-!q_64-0 . . �?v x, , . . (T'� �1
Nouse No. Street Hamlet
Owner or Owners of Property � rz, - ��tL f .�•.. . . . . . . . . r
County Tax Map (N„oy.4( .1
. . .oy, % . . . . . . . Block . . f!(. . .j.1 /. . . . Lot . �[, �. . . . . . . .
Subdivision ?' M ���rr.�J— f-a .. . . . .yg. . . . .Filed Map N\oj.� -t�7°. 1.t. . . .Lot No / . . . . . . . . .
Permit No. . . �� �. Date of Permit `: _N'Applicant
Health Dept. Approval . . . . .� .. xr7(?. .-. . ` . . . .Labor Dept. Approval . . . . . . . . . . . . . . . . . . . . . ... .
Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval . . . . . . . . . . . . . . . . . .. • .
Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . . .Final Certificate . . . . .W:. . . . . . . . . .
Fee Submitted $ . :`. . . . . . . . . . . . . . . . . . . . .
Construction on above described building an per 'rmeets��appl{cabl�odes and regulations.
Applicant !'vv � . . . . . . .: . . . . . . . . . .
Rev. 10.10.78
I ac) 3�q
FIELD INSPECTION > DAiE COMMENTS
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FOUNDATION ( 13t )
FOUNDATION ( 2nd )2 .
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ROUGH FRAME &
PLUMBING
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INSULATION PER N . Y. H
STATE ENERGY
CODE x
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ADDITIONAL COMMENTS ; �d
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FORM NO. 1
TObVN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined .F.< :Z. ./.� , ., 194./�� Application No./. � ? /. . . . . . . .
Approved ��6. . .f.✓/e. . ., I9c�errnit No. ./z .6.
Disapproved a/c . . . :". . . . . . . . . . . . . . . .4(B4uilding,
. . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Inspector)
APPLICATION FOR BUILDING PERMIT
Date
.' . . . 11. . . . . ..x'. .?-T9 .
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi
Inspector,with 3 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 strer
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon apprc:al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern
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 whatever until a Certificate of Occupan
shall have been granted by the Building Inspector.
APPLICATION IS I-IERE13Y MADE to the Building Department for the issuance of a Building Permit pursuant to t
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in buildings for necessary ii pect'ons.
". . . . . . . . . . . . . . . .
(Signature of applicant, r nam a corp ation)
... .
(Mailing address of applicant)
State whe±her applicant is owner, Jesse agent arc!ritect, engineer, general contractor, electrician, plumber or build.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
../. . . .e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . .
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)
Builder's License No. 7-�. . . . . . . . . . . . . . . . . . . . . . .
Plumber's License No.- >
Electrician's License No. C, .1:':0. . � -!�a�
Other Trade's License No.
1. Location of land on which proposed work will be done. 0(2. . . , . ,
. . . . . . . . U�GL rf/ . . . . . . . . . . . . . . . . . . .
House Number g Street Hamlet
County Tax Map
No. 11000 Section . .1 . t oma. . . . . . . . . Block . . .O,L. .p. . . . . . . . . . Lot . 3.a l3 . . . . . . . . .
Subdivision . V . hf, �l.E�t�. .E,S.. . . . . . . . . . . . . Filed slap No. . . . . . . . . Lot '�k . . . . . . . . . .
(Name)
2. State existing use and occupancy of premises annd/intended use and occupancy of proposed construction:
a. Existing use and occupancy . . . . . IJ(?l 1Y:!�L�. . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . . . . . f. . . � . . . . .F.fe�z . . . !`. S... . . . . . . . . . . . . . . . . . .
3. Nature of work' check which a,
. ( � pplicable): New Building Addition . . , . . , . . . . Alteration . . . . . . . . . .
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . .
(Description)
Estimated Cost . 1 •Q.Qp�. . . . . . . . . . . . . . . . . . . . . . . . . . Fee . 57.- . . . . . . . . . . . . . . . . .T. . . . . . . . . . .
(to be paid on filing this application)
If dwelling. number of dwell )di units .c. . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . , , ,
� o
Ifgarage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
i. 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 ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . , . . . . . . . . . . . . . ,
Depth . . . . . . . . . . . . . . . . . . . � ' ' Height , , , . . , . . . . . . . .
Number of Stories . . . . . . . . . . . .
i. Dimensio�sfentire new construction: Front . �-0 . , , , , , . . . Rear . 44 , . . . . . . . . Depth .'o8. . . . . . . . . . .
Height , � rN unber of Stories . ; . . . . . . . . . . . . . . . . . . . .
, . . . . . . . .
). Size of lot: Front . . (a0 . . . . . . . . . . ... ... Rear . .�3�. . . . . . . . . . . . . . . . Depth 3.45 . . , . . . . . . . . . . . . . .
). Date of Purchase . . . . . . . . Name of Former Owner . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .
1, .Zone or use district in which premises are situated . . . . . . ,'. . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . .
2. Does proposed construction violate any zoning law, ordinance or regulation: .
3. Will lot be regraded . . . . . . . .,. 'Ir6. . . . . . . . . . . . . . Will excess fill be removed from premises: Yes
1. Name of Owner of premises . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . , . . .
Name of Architect . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . .
Name of Contractor i. . . . . . . Address (a7. ��M f-V,rrir�, OjUhone No. Lt.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from
roperty fines. Give street and block number or description according to deed, and show street names and indicate whether
.tenor or corner lot.
Y
TATE OF NEWV YORK, S.S
OUNTY OF .\.�{I5.u�,-P�-1'R�.�`��T��V� 1
D � . • . • . . . . . being duly sworn, deposes and says that he is the applicant
(Asme ofindividual sig
(ting contract)
)ove named.
eisthe . . . . . . . . . .Rrr-, 1 . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Contractor, agent, corporate officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
)plication; that all statements contained in this application are true to the best of his knowledge and belief;and that the
'ork will be performed in the manner set forth in the application filed therewith,
wom to b'efore,ipe this
I . . . . . . . . . .day of. . , ,1, . . .� 19 4a`
otary Public, .
No u,w PUBt H:, 4(et9 of Now Y0 r
- No. 52-45{4%71. . . ��uu//,,,. -
Qualified in Mk county (Signature of applicant)l
- I
Commission Expires
March 30, 198.2.. . ,
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SURVEY FOR
suFForat couaTTy xEAz�T� nzr9�f�T�ENT STALLER ASSOCIATES
q LOt 13, OREGON VIEW ESTATES" JUNE 25,1982
DATE_ AUG a 2 �9gZ A. D. RAF. #_10- r MAR. 2, 1982
AT CUTCHOGUE DATE: JAN. 19, 1982
The IlokamodisnosFl and e;irLer s»?Tay TOWN OFSOUTHOLD SCALE: 1 =50'
ta<;ittttos for t,�is lcc:aion h va been SUFFOLK COUNTY, NEW YORK NO. 82-21
lnsper,+.e�' by 17as �1o(�artm�l.Tt and found _
t0 ?le sflti SfaC$ory *UNAUTHORIZED TITEROF ON OR SECTION 709 1D THIS
w SURVEY M A VIOLATION (1F SECTION 7203 OF THE
NEW YORK STATE EDUCATION LAW
Chief Of GOI:eTait P:n,,ineoring *COPIES OF THIS SURVEY NOT BEARING THE LANDNF)y
SURVE.YOR's INKED SEAL OR EMBOSSED SEAL SHALL S Y
Services NOT,BE CONSIDERED TO BEA VALID TRUE COPY µD 1y Q
*GUARANTEES INDICATED HEREON SHALL RUN ONLY TO SIL
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- '
*NEAREST WATER MAIM ML S NSOURCE OF WATER- PRIVATE Y-PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED
It SUFF CO. TAX MAP DIST SECTION 995.-SLOCK Qom.LOTJ= HEREON,AMC TO THE ASSIONEES OF THE LENDING
*THEME ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTIgq11 GUARANTEES ARE NOT TRANSFERABLE '
OTHER THAN THOSE SHOWN HEREON. TO ADOITIOHAL INSTITUTIONS OR SUBSEQUENT
*THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LINES • . 4+S
TO EXISTING STRUCTURES ARE FOR A SPECIFIC F'
�`PCANT SERVICES. PURPOSE AND ARE NOT TO BE USED TO ESTABLISH p ^Y y
PROPERTY-LINES OR FOR THE ERECTION OF FENCES (A 5044 O !"
A4DR£SS .l
TEL. YOUNG a YOUNG RIIVVERHEAD, NEW YORKE
■=MONUMENT 13-STAKE
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ALDEN W.YOUNG,PROFESSIONAL ENGINEER
ON APR.4,1970 AS FILE NO.6241. AND LAND SURVEYOR N.Y.S.LICENSE NO.12845
HOWARD W.YOUNG, LAND SURVEYOR
*THE LOCATION OF WELL(W),SEPTIC TANK(ST)BCESSPOOLS(CP)SHOWN HEREON N.Y.S.LICENSE NO.45893
ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS
TELEDYNE 5T NOW9
\ey
oF° ry� N 132 FF) I V A'.P1
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N "dt Should be noted that since th
OL�
Property the s located in an agricultur I
Cj C1 possibii5ty exists that th
water
SBe . anTounts of supply May contain trac _
/ Jy op 3�i 0 (� Q l sticides and/or nitrates.
b90 �!3 ryryy9ry4 D�0
Special analysis .�� lKrequired.
SURVEY FOR
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES STALLER ASSOCIATES
LOT 13, "OREGON VIEW ESTATES"
FOR APPROVAL OF C''(DNSTRU4'YION ONU° AT CUTCHOGUE DATE: JAN. 19, 1982
TOWN OF SOUTHOLD SCALE: I" =50'
Ns RrF, NO __.p �.�t1_.��'�, SUFFOLK COUNTY, NEW YORK - NO. 82-21
N UNAUTHORIZED ALTERATION OR ADDITION TO THIS
SURVEY IS A VIOLATION OF SECTION 7208 OF THE
NEW YORK STATE EDUCATION LAW
N COPIES OF THIS SURVEY NOT BEARING THE LANDOF �E)b'
SURVEMR•S INKED SEAL OR EMBOSSED SEAL SHALLOT BE CONSIERED TO BE A VALID TRE 4,'` j'0
Gc� NGUARANTEESDINDICAT D HEREON SALL RUNPONLY TO �PFtD W, rQ �f
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN-
RNEAREST WATEII MAIN NL I NSOURCE OF WATERS W/11MTE,�PUBLIC� MENTAL AGENCY AND LENDING INSTITUTION LISTED
N SUFF CO. TAX M ► OISTIMQQSECTION 095 BLOCK.04 LOT 18.13 HEREON,AND TO THE ASSIGNEES Of THE LENDING 1 ��
N THERE ARE NO DWELLINGS WITHIN 100 FEET OF TING PROPERTY INSTITUTION. GUARANTEES ARE HOT TRANSFERABLE
OTHER THAN THOSE SHOWN HEREON. TO ADDITIONAL INSTITUTIONS ON SUBSEQUENT
K THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS
WILL CONFORM T14 THE,STAN SOF THE SUFFOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LINES 3
APPLICANT, 'E"" U�,' PURPOSETOEXISTNG AND ARE NOTE TO BE USED TO ESTABLISH FOR A SPECIFIC �6P'F,p 89"'
PROPERTY LINES OR FOR THE ERECTION Or FENCES FD( N SON
ADDRESS- -. (.�
` TEL ��Y YOUNG a YOUNG 4W OSTRANDER AVENUE
M+MONUMENT ❑•BTANE RIVERHEAD* NEW YORK
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ALDEN W.YOUNG,PROFESSIONAL ENGINEER
ON APR.4.IB70 AS FILE N0.6241. AND LAND SURVEYOR N.Y.S.UCENSE NO.12845
HOWARD W.YOUNG, LAND SURVEYOR
N THE LOCATION OF WELL(W),SEPTIC TANKIST)B CESSPOOLS(CP)SHOWN HEREON N.Y.S.LICENSE N0.45893
ME FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS
TELEDYNE:OST N01779
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b I a� fcSNS10� S>�bfd QED PefL D45ENEfutYZbpt 6 NOTEf-�Y BUILDING /
LAMY YE �'�� l + ` FEE
�d 765-IPO? 9 AM TO 4 PM FOR THE
DEPARTMENT AT
IUrn ' - 1, FOUN^ATION - TWO REQUIRED
FOLLO` LIN(; INS.°ECTIONS:
q/� G12 \ �yryl Xl�� Grtlf' i FOR P^UP°fl CONCRETE
2, ROUGH - FRAMING S PLUMBING
3, INSULATi -N
A, FINAL. CONSTRUCTION MUST
BE COFOR C. 0.
16 as is asK Ns ALL CONSTRUCTIONtAlrrPSHALL MEET
THE.1A.-X to m li�lil}L - o.x 6ui M40
-
"�� 811 Y AW' DES46N OR CONSTRUCTION ERRORS
AENTS OF THE N.Y.
/�"&lCf Iu5J1_ W17. 1tAPRR..2rMb5R �„ \ .yi16.:
� YE �� rTE CONSTRUCTION & ENERGY
STA, CO U E
_ _. CO®E5. NOT RESPONSIBLE FOR
15 FELT Ird�- 9RI tw'irUrL
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FOLLOWING INSPECTIONS:
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FOR POURED CONCRETE '
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
11 p ! BE COMPLETE FOR C. 0.
ALL CONSTRUCTION SHALL MEET
I, f I ! A'' L �1 • bj THE REQUIREMENTS OF THE N. Y.
STATE CONSTRUCTION & ENERGY
CODES NOT RESPONSIBLE FOR
- I �� I� �' - nj� • ' ��� DESIGN OR CONSTRUCTION ERRORS.
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