HomeMy WebLinkAbout1000-113.-3-7.2 TOWN OF SOUTHOLD
°m Rental Permit
a
0599
Owner IDK Mansion LLC
Occupied as Single Family Dwelling
Located at 105 Mill Road Mattituck 113-3-7.2
Maximum Permitted Occupancy 10
Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of
the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is
two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection.
s
2/16/20221)tL _
C dEn�F r rte nt fi�wal
This Notice must be posted by the main entrance at all times
-'AN-M�\
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Town Flail Annex o T (631)765-1882
54375 Main Road _ Pax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 � �
BUILDING DEPARTMENT
' _
TOWN OF SOUOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee $200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION -BLOCK 03 -LOT--j
SECTION B.
OWNER INFORMATION:
Property Owner Name: C�✓� S
Property Owner Legal Address: Property Owner Mailing Address:
Me bx e
Telephone Number (s): Daytime's OT-34vening Z Emergency-q,514 2-42312--
Property Owner Email Address: � � �
� a�b
JUN 1 LULU
lk' iwx)o
Page I of 5
Town HaII Annex o Telephone(631)765-1802
_ -S
ax 631
54375 Main Road � ��� l ( )765-9502
P.O.Box 1179 ,
Southold,NY 11971-0959
BUILDING DEPARTMENT
TONM OF SO OLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: to
Address of Authorized Agent (no P.O. Boxes): —. _ -
Mailing Address of Authorized Agent:
Telephone Number (s): Daytime_-- Evening_ Emergency
Email Address:
Section D.
Managing Agent Information:
P
Name of Authorized Agent of dwelling unit, if any: I
Address of Authorized Agent(no P.O. Boxes):
Mailing Address of Authorized Agent:
Telephone Number(s): Daytime Evening Emergency
Email Address:m
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units)
Name of Managing Agent of dwelling unit, if any:
Address of Managing Agent (no P.O. Boxes): -�
Page 2 of 5
Town Hall Annex \� � � �A� Telephine(631)765-1802
54375 Main Road �V `� Fak(631)765-9502
P.O.Box 1 179 \ \ \
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
Telephone Number (s): Daytime Evening Emergency
Email Address:
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property:
For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier (for example,
Unit 1, Unit 2, Unit 3 or Apt A, B, C);the use of each room in the Rental Dwelling Unit
(for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each
room.
For properties with multiple Rental Dwelling Units use "Rental Permit Application
Addendum."
Rental Dwelling Unit Identifier:
Requested Maximum number of persons allowed to occupy Dwelling Uit: _
Number of rooms in Rental Dwelling Unit; '11 ,
�Use and Dimensions of each room in Rental Dwelling Unit: !� ffi � �
W it . � �
. aov) I
Rawl mil �Ix ZA ,
Page 3 of 5
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Town Hall Annex ��� �� Telephone(631)765-1802
54375 Main Road \ \ Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOED
SECTION G.
INSPECTION:
Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety
inspection by Code Enforcement Official is required. If the owner chooses not to have said
inspection performed by the Town, a certification from a licensed architect, a licensed
professional engineer or a home inspector who has a valid New York State Uniform Fire
Prevention Building Code Certification is required stating that the property which is the subject
of the rental permit application is in compliance with all of the provisions of the code of the
Town of Southold,the laws and sanitary and housing regulations of the County of Suffolk and
by the laws adopted by the New York State Fire Prevention and Building Code Council.
Xi am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold
❑ 1 am submitting a completed Town of Southold certification form from a licensed
architect or a licensed professional engineer.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit
STATE OF NEW YORK)
}
COUNTY OF SUFFOLK)
certify under penalty of perjury,the following:
1. 1 am the owner of the property identified in "Section A"of this application.
2. The property owner's legal address set forth in "Section B" of this application is my legal
address and I understand the Town will use the address for service pursuant to all
Page 4 of 5
Town Hall Annexes Telephone(631)765-1802
54.375 Main(toad
Fax(631)765-9502
P.O.Box 1179
Southold,NY 1 197 1-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
applicable laws and rules. I further acknowledge that I will notify the Town of Southold
Building Department of any changes of address within five (5) days of any changes
thereto.
3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and
agreed to abide by the same.
4. 1 will notify the Town within five (5) business days as to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager.
Property Owner's Nam `
Property Owner's Signature•
Swo to before me da of
Official Notary Public Signature and Original Notary Stamp
B HEN E BRUZGA
Notary��1 � 4868033State of eW York
()ualitled in Suffolk county202
My Commission Expires Aug.
Page 5 of 5
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] -FOUNDATION IST [ j ROUGH PLBG.
[ ] .FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING / STRAPPING [ ] FINAL
LACE & CHIMNEY SAFETY INSPECTION
[ ] FIREPLACE [ ]
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE-RESISTANT PENETRATION
[ ] ELECTRICAL-(ROUGH) [ ] ELECTRICAL (FINAL)
] CODE VIOLATION [ ] PRE C/O
REMARKS: I ) Av
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F SOUTHOL�[ BUILDING DEPT.
TOWN
7651802
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INSPECTION
( ] FOUNDATION 1ST [ ] ROUGH PLBG.
( ] FOUNDATION 2ND ] INSULAIOICAUL ING
[ )(FINAL
[ ] FRAMING /STRAPPING
( ] FIREPLACE & CHIMNEY [ ]
FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ]
LODE
(ROUGH) [ ] ELECTRICAL (FINAL)
[ CODE VIOLATION [ ] PRE C/O
REMARKS:
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617
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Tb� INSPECTOR
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
[ ]
FOUNDATIONlST [ ] OUCH PL G, '
[ ]
FOUNDATION21SID INS L TION/CAUL G
[ ] FRAMING /STRAPPING ] /FINAL
[ ]
FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ]
ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ]
CODE VIOLATION [ ] PRE C/O
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FORK NQ 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Date . . . . . . . . . . . . . . . . . . . . . . ., 1977
& W.IMIill Road
THIS CERTIFIES that the building located at Cox.beck y .Breakwate r.9. . . Street
Map No. . . xzx. . . . . . Block No. . . .Txx . . .Lot No. x= . . . Mat t ituck. . 11.Y.•. .
r a _ert s o o a .aud 'two N.0
conforms substantially to the Faat ily
units,
bulIt c i to of occu nab
ated .befor4, . .Apr. 23 . . . ., 19.57. pursuant to which
dated . . . . . . . .4W . 23 . . . . . .. 19.77., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .l` in one tf aa�. dw3. ! F.C. p famil. y dvlS j F.C. . . . ,1Punit dwe lip , with
two car garages root cellar
st45tferbuilding
easoaccessory structures.
ord
The certificate is issued to . . , . eT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval M7. existing. . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No. Rr9-QX r?t1X1g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HOUSE NUMBER . . .105_ . . . . . . . Street .WOAt .MIA .I.„AQ . CRD) . . . . .lfat.t i,tuok . .
50-250 Breakwater Road
Notes New owner vi?l have to register under the Multiple residence Law
Building Inspector
HOUSING CODE INSPECTION
August 19, 1977
#105 W. Mill Lane & 50-250 Breakwater Road R-2
Mattituck, N.Y.
Tax Roll: Paul Cerrito and ors.
Occupied: Owner, seasonal
Upon receipt of an application for a Pre-Existing Certificate
of Occupancy, I made an inspection of the buildings on this prop-
erty. Accompanied by Mr. Cerrito, I began this inspection at
approximately 10 :05 A.M.
MAIN DWELLING
A two-story wood framed structure constructed on a red brick
masonry foundation. First floor contains two kitchens, two dining
rooms, two living rooms, a bedroom, and a full bathroom. Second
floor contains six bedrooms and two bathrooms. Heat is furnished
to all rooms except kitchen on northeast corner of first floor
from an oil fired steam heat furnace located in cellar.
BUILDING #2
A two-story wood framed structure constructed on a red brick
masonry foundation. First floor apartment contains a kitchen,
full bathroom, and two bedrooms. Second floor apartment is ac-
cessible by exterior stairway and contains a kitchen, full bath-
room, and two bedrooms. Entry to partial cellar is accessible
from screened and roofed over patio attached to rear of building.
BUILDING #3
A two-story wood framed dwelling with red brick masonry
foundation. This stricture contains four apartments. First floor
apartment on west end of building has a kitchen, full bathroom, and
a bedroom with a half bath. Second floor entry is through an ex-
terior door with interior stairway adjacent to west apartment. This
apartment contains four bedrooms, full bathroom, kitchen, and dining
room. There are two first floor apartments on the east end of
building. South apartment contains a kitchen, full bathroom, and
a bedroom. A utility room accessible from this unit contains gas
fired hot water heater and electric water pump that supplies domestic
water to all living units within this building. Apartment on north
end has a kitchen, full bathroom, and a bedroom. All units in this
building have separate entrances from exterior. A large roofed over
screened enclosed patio is located on west end of this building.
Accessory structures on premises include a wood framed two-car
garage, a root cellar, and a small storage building, wood framed,
stocco exterior.
The following violations of the Housing Code, Chapter 52, Code
of the Town of Southold, New !.York, were found:
Page 2
MAIN HOUSE
Kitchen - gas cooking range, no shut off valve at unit,
F-r-ticle V, Section 52-52 B 2.
Bal-- - second floor, posts supporting railings are
excessively loose, Article IV, Section 52-30 A.
Bedroom - northeast, light fixture in closet not properly
mouse , Article V, Section 52-56 A 1.
Electrical switches - top landing of cellar stair, outside
lights and emergency switch for hotwater heater, both
require plates, Article V, Section 52-56 A 1.
Hot water heater - electric switch at unit not properly
63-URtea aR3 requires plate, Article V, Section 52-56 A 1, 2.
Cellar stair - bottom treads are loose and uneven, Article III,
Se tlo - 0 A.
BUILDING #2
First floor apartment:
Entry - no means of controlling light in room at point of
entry, Article V, Section 52-56 B 2 .
Gas cookin2 range - no shut off valve at unit, Article V,
Section 52-52 B 2.
Second floor apartment:
Stairway - no means of controlling light for safe ascent or
scent, Article II, Section 52-26 B 3.
Entry - no means of controlling light in room at point of
entry, Article V, Section 52-56 B 2.
Gas cookin2 ran2e - no shut off valve at unit, Article V,
Section 52-52 3 2 .
Cellar - house trap connection to clay tile pipe leaking at
30! Article V, Section 52-51 A. Pit containing electric
water pump is open, no hand rail or equivalent protection,
Article II, Section 52-27 B. Hot water heater, gas fired,
vent terminates in cellar, Article V, Section 52-53 H 3.
Electric service and fuse panel requires cover, unprotected
connections, wires project beyond panel box, Article V,
Section 52-56 A 1. Ceiling light fixture not properly
mounted to junction box, Article V, Section 52-56 A 1.
Chimney - on exterior of building, thimble for smoke stack
connection broken through diameter of thimble, Article V,
Section 52-54 A 1 & 2.
Page 3
BUILDING #3
West apartment, first floor:
Kitchen - gas cooking range, no shut off valve at unit,
Article V, Section 52-52 B 2.
Second floor apartment:
Kitchen - gas cooking range, no shut off valve at unit,
Article V, Section 52-52 B 2.
Stairway - winder treads first four risers, insufficient width
of tread, Article II, Section 52-26 A.
Southeast apartment, first floor:
Kitchen - gas cooking range, no shut off valve at unit,
ArElcle V, Section 52-52 B 2.
Utility room - electric panel box, no panel cover, electrical
switch for iTxterior light requires switch plate, Article V,
Section 52-56 A 1. Gas fired hot water heater for entire
building, room not ventilated for heat producing equipment,
Article V, Section 52-53 G 1, 2 .
Northeast apartment, first floor:
Kitchen - gas cooking range, no shut off valve at unit,
Article V, Section 52-52 B 2.
Buildings 2 and 3 do not have central heating systems or
means of providing heat to living units. Occupancy for seasonal
use permitted during period between June 1st and September 15th
of calendar year, Article V, Section 52-53 A 1.
Inspection completed at apprqk'-Inately 11:10 A.M.
Resigkictfull submitted,
id ArAd, Hi C"e
Building inspector
EH:med
FORM NO.4
w
TOWN OF SOUTHOLD
BUILDING DEPARTMENTlyiA
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. . . Z 15866 , . . . , , . June 1 9 , 1 987
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
THIS CERTIFIES that the building . . A c c e s s o r y . . . § _ .
Location of PropertyBreakwater Rd . & 105 Mill Road Mattituck
!-louse No, Street - - - - -Hamlet
County Tax Map No. 1000 Section . . 3. . , . . . .Block 3 . . . . . . . . . . .Lot . . .007 2. . . . . . . .
Subdivision Arlene Mary i n -M i nor . .Filed Map No. 141. . . . .Lot No. . . . . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
June 1 1 , 1984
. . . . . . . . . • . . . . . . . . . . . pursuant to which Building Permit No. . 13.2.2.5 7. . . . . . . . . . . . .
dated .June 14 , 1984. . . . . was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for whicli this certificate is issued is . . . . . . . . .
„Accessory storage building as applied for£.{
The certificate is issued to . , ,MICHAEL AND JOYCE MATTES
. . . . . . . . . . . . . . . . . . .
of the aforesaid building.
Suffolk County Department of Health Approval . . . . . . , . - . . N/A. . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . N/A . . . , _ . . . , . , . . . , . , . . . . . . .
PLUMBERS CERTIFICATION DATED: N/A
. . . . . .
Building Inspector
Rev.1/81
r
A
FORM NO.4
41 e _
TOWN OF SOUTHOLD
BUILDING DEPARTMENT A
Office of the Building Inspector
Town Hall
g
Southold, N.Y.
Certificate Of Occupancy
No. , 215867. . . . . . Date . June 19 , 19847 . . {
. . . . . . .
THIS CERTIFIES that the building . . . .Porch. ; { . . . . _ . . . . . . . . . . . . . . . . ¢
Location of Property50 Breakwater Rd; & 105 Mill Road Mat tituck
House No. Street Hamlet
County Tax Map No. 1000 Section . . 1.1.3. . . . . . .Block . . .93. . . . . . . . . .Lot . .9 9?.•. 2. . . . . . . . .
Subdivision . Arlene Marvin---Minor . , , , ,Filed Map No. ,1.49. . . .Lot No. . . .1. . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
O c t o b e r 281 9 8 5 pursuant to which Building Permit No. . , .1.4 4 2 5 2 . .
dated . Nov ember 6 , 1 9 8.5. 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 , . . . . . . . .
. . . . . . E,nclosed porch as appliedfor... . . . . . . . . . . . . . . . . . ..
The Certificate is issued to . Michael and Joyce Mattes
. . . . . . . . . . . . . . . . . . .
of the aforesaid building.
Suffolk County Department of Health Approval . . , . . . . . . , , N/AF . . . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . .Pending 6/ 15 /87.
, ,
PLUMBERS CERTIFICATION DATED: N/A
Building Inspector
Rev. 1181
FORM NO. 4
TOWN OF SOUTHOLD ?
BUILDING DEPARTMENT _ t
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-15583 Date NOVEMBER 21L. 1989
THIS CERTIFIES that the building ADDITION TO ACCESSORY
Location of Property 1.05 IfESTMILL ROAD & 50 BREAKWATER _ MATTITUCKNY
House No. Street Hamlet
County Tax Map No. 1000 Section 1.13 Bloch 3 Lot 7.2
Subdivision Filed Map No Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated-OCTOBER 3, 1989 pursuant to which
Building Permit No.18562-Z dated OCTOBER 5, 1989
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 GARAGE ADDITION TO EXISTING ACCESSORY SHED AS APPLIED FOR.
The certificate is issued to MICHAEL MATTES
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-32286 Date: 434/10/07
THIS CERTIFIES that the building ADDITION
Location of Property: 105 MILL RD MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 113 Block 3 Lot 7.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUAR 21, 2007 pursuant to which
Building Permit No. 32754-Z dated FEBRUARY 26, 2007
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 "AS BUILT" DECK WITH OUTDOOR ISLAND SINKS & HOT TUB ADDITION TO AN
EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JACQUELINE ENTENMANN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 07-2076 03/30/07
PLUMBERS CERTIFICATION DATED 03/29/07 GARY STAHL
Authorized Signature
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-32285 Date: 04/10107
THIS CERTIFIES that the building ACCESSORY
Location of Property= 105 MILL RD MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 113 Block 3 Lot 7.2
subdivision - Filed Map No. Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 21, 2007 pursuant to which
Building Permit No. 32754-Z dated FEBRUARY 26,_ 2007
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 "AS BUILT" ACCESSORY OUTSIDE SHOWER AS APPLIED FOR.
The certificate is issued to JAC2UELINEE ENTENMANN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N LA -
ELECTRICAL CERTIFICATE NO. 07-2076 03/30/07
PLUMBERS CERTIFICATION DATED 03/29/07 GARY STAHL
#
Au prized Signature
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT )
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25968 Date: 09/11/98
THIS CERTIFIES that the building ADDITION
Vocation of Property: 50 BREAKWATER ROAD MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 113 Block 3 Lot 7.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 27, 1992 pursuant to which
Building Permit No. 20462-Z dated MARCH 3, 1992
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 INGROUND SWIMMING POOL ADDITION TO AN EXISTING ONE FAMILY DWELLING
WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to MICHAEL & JOYCE MATTES
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 235805 05/18/92
PLUMBERS CERTIFICATION DATED N/A
Bu44ing Inspe -tsr
Rev. 1/81
L-Zl i�
Numberof pages
'j-IV ..,
This document will be public _4
record.Please remove all ,-
Social Security Numbers E
prior to recording. - 3
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording 1 Filing Stamps
3
FEES
Page/Filing Fee t Mortgage Amt.
1.Basic Tax
Handling 20. 00
2. Additional Tax
TP-584 Soo Sub Total
Notation SpecJAssit.
r
EA-5217(County) °j oo Sub Total J !. 5peoc./Add,
EA-5217(State) I ZS°p TOT,MTG.TAX
Dual Town Dual Count
Held for Appointment
Comm,of Ed. S. 00 TransferTax 3 �
Affidavit Mansion Tax
Certified Copy - The property covered by this mortgage Is
or will be Improved by a one or two
NYS Surcharge `5. family dwelling only.
Sub Total [ YES or NO
Other
Grand Total ��_^ If NO,see appropriate tax clause on
page N of this instrumenL
/Zl
4 Dist.100( 11 1126471 1000 11300 0300 007002 )")L 5 Community Preservation Fund
Real Property I R VIT � Consideration Amount$i O
Tax Service I _
Agency 2-NOV-1 CPE` `a:Due $—A-12>.;>
Verificatlon `
Improved ✓
6SatisfactionsrDischarges/Releases List Property Owners Mailing Address
RECORD&RETURN TO: Vacant Land
C4PA jkjQSSi ES�. TD �U
iii ` JJlessi, LLP
5r7 W
`'est 38ti, 5+'ee-t TD
Ncw IOVrk� N 1 )00)8 TD
Mail to:Judith A. Pascale,Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 co Name ?OStOr1 `,� d j iH
www.suffolkcountyny.gov/clerk Title
s Suffolk Coun Recordin & Endorsement Pe
This page forms part of the attached to made
by: 1 (SPECIFY TYPE OF INSTRUMENT)
,` nmll n The premises herein Is situated In
SUFFOLK COUNTY,NEW YORK.
TO IntheTOWNof � �
i�rzyli rl ( t�i In the VILLAGE n
or HAMLET of IV`alTl�C� -
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
77-7-
)