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HomeMy WebLinkAbout24928-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26312 Date: 03/02/99 THIS CERTIFIES that the building ADDITIONS Location of Property: 475 LAKE DR SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 80 Block 3 Lot 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 30, 1998 pursuant to which Building Permit No. 24928-Z dated JUNE 2, 1998 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JEAN ROTERT (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-480007 02/12/99 PLUMBERS CERTIFICATION DATED 02/02/99 MATTITUCK PLUMB.&HEATING )'4 L'�O'�o� Building Inspe5p6r Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 24928 Z Date JUNE 2 98 Permission is hereby granted to: JEAN ROTERT A/C E .E . 231 CANTERBURY DR RAMSEY,NJ 07446 for CONSTRUCTION OF AN ADDITION AND DECK ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR AND TO CHAPTER 46 FOR FLOOD PREVENTION. at premises located at 475 LAKE DR SOUTHOLD County Tax Map No. 473889 Section 080 Block 0003 Lot No. 017 pursuant to application dated MARCH 30 98 and approved by the Building Inspector. Fee $ 175 .00 Building Inspecto ORIGINAL Rev. 2/19/98 Form No. 6 \1 TOWN OF SOUTHOLD SCR BUILDING DEPARTMENT TOWN HALL BLDG.DEFT. 765-1802 1OWN O.ESOUTH06D APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter'OR ink and submitted to the building inspector with the following: 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 a 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. r C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. 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 $15.00,0,, Commercial $15.00 Date . .'� /a et./Z./ . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . ...' Old Or Pre-existing Build ng. . . . . . . . . . . . . . . Location of Property. . . . . .q 7.5- . . . . . . . . . . . . � . . . . . House No. Street Hamlet Onwer or Owners of Property. . �� pp . . .2 0' U— . . . . . . . . . . County Tax Map No 1000, Section. . Q.W . . . . . .Block. . . . Dp.3 . . . . .Lot. . . . . . . . . . . . . . . . Subdivision__.(RY4.CN�. .��046-.b . . . . . . . . . .Fipleed Map.U.I.z. . . . . .Lot. . . ` . . . . . . . . . . . . . . . . . Permit No. .q>?g9P k .. . Date Of Permit. . /.:l�.C . . . . .Appli ant.�/V!�� � �I�? ti} .C'. �r_ Ou/ti✓r>-e-- Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate . . . . . . Gt/ Fee Submitted: $. .a.E . . . . . . . . . . . . . . . . . . . . 6Ze4- TS8f . . . . . . . . co ?,w C 1 y PLICANT � a aid THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 F BUREAU OF ELECTRICITY I 40 FULTON STREET, NEW YORK, NY 10038 Date FEBRUARY 12,1999 Application No. on file 16933398/98 N 480007 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of J & is ROTERT, 475 LAKE DRIVE, SOUTHOLD, NY in the following location; ❑ Basement ® 1st Fl. ❑ 2nd Ft. OUT Section Black Lot was examined on FEBRUARY 08,1999 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT1 FLUORESCENT I OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 7 15 13 7 1 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT WATTS 2 SERVICE DISCONNECTNO.OF S E R V I C E METER NO.OF CG COND A.W.G A W.G. AMT. AMP. TYPE EQUIP. 1 0 2W 1 0 3W 3 0 3W 3 0 4W pER 0 Of CC.COND. NO.Of HI-LEG OF HI-LEG NO.OF NEUTRAL$ OF NEUTRAL OTHER APPARATUS: PADDLE FA214-1 G.F X.I:-2 SM01M DETECTOR:-4 PAUL R. BURNS LIC.#3897 ( ow= PO BOX 1061 SOUTHOLD, NY, 11971-0932 GENERAL MANAGER 11 Per This certificate must not be altered in any manner;return to the office of the Board if incorrect.Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. In FEB TOWBLOG.DEPT r Town Hall,53095 Mein Road i ? 23 P. O. Box 1179 Telephone(516)765-18 Southofd, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O YET DATE: Building Permit No. / � Z Owner: �e fes— (please print) — Plumber: MATTzTUCk &LOM8/h/6 /�EJaT/h(G (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ( lumbers ig I ; Sworn to before me this aa_ day of19 Notary Public, County NMeryNPOu O 7 Qpires Jun I�� Term Expires June 3. I_I nasi ii�alri�� 11 . • ZAA A l 0 (�aiL6 � _ r .N / • J� 1 L� �t�� -� " F4 42 r. .f 7 -}- ---, 6 UN(lC _ t TSI l i y `-s Environment East, Inc. 2885 Indian Neck Lane P.O.Box 190 _ Peconic,New York 11958-0190 516-734-7474 Fax:516-734-5812 Rotert Residence Lake Drive Reydon Shores,Southold Permit#24928 Z February 5, 1999 Dear John; As you requested during your inspection this morning, I have revised the plans for this addition to include the changes made in the laundry room and bedroom and also eliminated the hallway door. I enclose three copies for your records. Thank-you J n Wilson r Jocck STUDS Aft- EGR«SS Wi,U \A/S TO ME=T NE� ;'OR1C S`iATE F;=�E COG` i GG _ss is o =so rt = - OT RTtD�t�C� --- -T SCALE: =/�J Q APPROVED BY j//,JL DRAWN BY X28 Z 1` DATE: Z� Z, ;J� �� J F `� i i DRAWING NUMBER - Z CHARRETTE PRO-FORM 920PF PRINTED ON 900H CMRPRINT VEl UM {(-.t-.T,'�1�„ -PAM Wkg Tat (S ad @&g/e Time yyM 4't - i Environment East, Inc. a 2885 Indian Neck Lane i P.O. Box 190 _ Peconic,New York 11958-0190 f _ _ 516-734-7474 Fax:516-734-5812 f FEB d 19.98 .w February 4, 1999 DEPT. ¢, TOWN F O OLD Southold Town Building Dept. P. O. Box 1179 Southold,NY 11971 Dear Sirs, Please find enclosed a window detail stamped by an engineer for the Rotert Project, permit#2492 Sincerely, Peter R. Stout President Environme t t, Inc. Encl. J^ V" Co SC!'c�t PRS:jm i D DU(3LE I Jiccv- STUDS C'_.AR ef=E'��1UC, j q�Cv T'H, ^ I r i ALL- E6RcSS WIQcoV✓- TO ME=T d 3 I 1 „Zq 41 d �r 3 4 LFG�L --Fo€ls0OTr i - r' JUDITH T. TERRY ( + "° Town Hall, 53095 Main Road TOWN CLERK y;. , �, P.O. Box 1179 f' e Southold. New York 11971 RECISTIWi OF VITAL STATISTICS Fax (516) 765-1823 MARRIAGE OFFICER ��©� Telephone (5161765-IROI RECORDS MANAGEMENT OFFICER O,1 �" 1 FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93) ] , and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)) . �ti✓V. I)LC'T. TOWN OF SOUTIiOLD �h T. Terry Southold Town Clerk August 25, 1993 i APPLICATION #_ PAGE I of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sign): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I,THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, TO ST F MY KNOWLEDGE, TRUE AND ACCURATE. (APPLICANT'S SIGNATU ) DATE 6 Q 0 SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANT) NAME ADDRESS _ TELEPHONE APPLICANT � . BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION # PAGE 2 OF'4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE 0 New Structure 0 Residential (1-4 Family) 11 Addition ❑ Residential (More than 4 Family) ❑ Alteration D Non-residential (Floodproofmg? U Yes) IJ Relocation 11 Combined Use (Residential & Commercial) ❑ Demolition l7 Manufactured (Mobile) Home (In Manu- 0 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: • Fill ❑ Mining ❑ Drilling ❑ Grading O Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) • Drainage Improvements (Including Culvert Work) • Road, Street or Bridge Construction O Subdivision (New or Expansion) d Individual Water or Sewer System El Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. Dated The Proposed Development: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). Cl Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) 0 Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4• ADDITIONAL INFORMATION REOUIRED(To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: • A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development pians,drawn to scale,and specifications,including where applicable:details for anchoring structures,proposed elevation of lowest floor(including basement),types of water resistant materials used below the fust Boor,details of floodproof ng of utilities located below the first floor and details of enclosures below the first floor. Also, •Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. • Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5 PERMIT DETERMINATION (-To be completed by LOCAL ADMINISTRATOR I have determined that the proposed activity: A. 0 Is B. 0 Is not in conformance with provisions of Local Law # , 19_. The permit is issued subject to the conditions attached to and made part of this permit. SIGNED DATE If BQX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may rcvise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # _ PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? O Yes O No Hearing date: Appeals Board Decision --- Approved? O Yes O No Conditions SECTION 6• AS-BUILT ELEVATIONS (To be submitted by APPLICANT' before Certificate aC Compliance is issued The following information must be provided for ptoject structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below; 1. Actual (As-Built) Elevation of the lop of the lowest Boor, including basement (in astal Hil;hHazard Areas, bottom of lowest structural member of the lowest Boor, excluding piling and columns) is: Ff. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofing protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? O YES ONO DATE BY DEFICIENCIES? O YES O NO DATE BY DEFICIENCIES? O YES O NO SECTION 9: CERTIFICATE OF COMPLiANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: f Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: O NEW BUILDING ❑ EXISTING BUILDING ❑ VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_1 AS MODIFIED BY VARIANCE # DATED ' SIGNED: DATED: rOL���Gy "y Town Hall. 53095 Man Road I' JUDITH T. TERRY 11 += -• '- t TOWN' CLERK P.O. Box 117Q tP ` Southold, New York 11071 REGISTRAR OR VITAL.STATISTICS t' a?j ( t""' �. Fax (516) 765-1823 MARRIAGE OFFICER • �•�` y�� Telephone 15161 765-1801 RECORDS MANAGEMEM'OFFICER FREEDOM OF INFORMATION OFFICER -a OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 : RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold : "Floodplain Development Permit Application" [FDP(93) ] , and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93) ] . [1 h TOWN OF SOUTHOLD ._. /J�udith T. Terry Southold Town Clerk August 25, 1993 APPLICATION #� PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sittn): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, T F ] EST OF MY KNOWLEDGE, TRUE AND ACCURATE. °G(APPLICANT'S SIGNAT RE) DATE SECTION 2: PROPOSED DEVELOPMENT (To be competed by APPLICANT) 73�-7Y-7� NAME ADDRESS TELEPHONE Q APPLICANT�1�Cr�dbw..--ad �ti.�B'S`Sti� BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) / APPLICATION # PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE El New Structure ❑ Residential (1-4 Family) • Addition ❑ Residential (More than 4 Family) • Alteration ❑ Non-residential (Floodproofmg? ❑ Yes) • Relocation 17 Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- El Replacement factured Home Park? 0 Yes) ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: O Fill ❑ Mining O Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage Improvements (Including Culvert Work) O Road, Street or Bridge Construction • Subdivision (New or Expansion) ❑ Individual Water or Sewer System • Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. Dated The Proposed Development: 0 Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ❑ Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable 0 The proposed development is located in a floodway. FBFM Panel No. Dated 0 See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REOUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: ❑ A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development plans,drawn to scale,and specifications,including where applicable:details for anchoring structures,proposed elevation of lowest floor (including basement),types of water resistant materials used below the first floor,details of floodproofmg of utilities located below the first floor and details of enclosures below the first floor. Also, ❑ Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted., ❑ Other: SECTION 5• PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. O Is B. O Is not in conformance with provisions of Local Law #_, 19_. The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # _ PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? D Yes O No Hearing date: Appeals Board Decision --- Approved? O Yes O No Conditions SECTION 6• AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued) The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: Fr. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community s local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? DYES ONO DATE BY DEFICIENCIES? DYES ONO DATE BY DEFICIENCIES? DYES ONO SECTION 8: CERTIFICATE OF COMPLIAN E(To be comnleted by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: r Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO, PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑ EXISTING BUILDING ❑ VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW #_, 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: C(C(93) nybLtU WA1tK UPUI PAGE 02 Federal.Emergency Management Agency Region 11 , 26 Falwal Phtza,Room 1337 New York, NY 10278-0002 December 12, 1997 ,Q .Mr. Williams. Necbmen ' Environmental Program Specialist 2grs� New.York State Department of cT Rnvironnibntal Conservation 50•Wolf Road, Albany, New York 12233-3507 Dear Mc.Nechamen: . This letter is in response to your request for guidance on National Flood Insurance program floodplain management standards for additions in a Special Flood Hazard Area(SFHA). The following explanatlon.is divided into two categories: l)floodplain management, and 2) flood irlsurablce ' . FLOODPI.AINMANAGEMENT CRI1EiRiA (A and V canes) o Pre=FZRMSir uctur" Imomvementit to F7RM Ctn.rt ores that consllture a abffrrdallnrprove wnt Existing strut wes.tbat are substantially improved are subject to the same requirements • . ' as would apply to new construction: If a structure built before the fust Flood Insurance ' .Rete Map(FIRM)or December 31, 1974(whichever is later)is substantially improved, 'w-hother due to rehabilitation or repair of damages caused by any emthe gndro stru a would need to be elevated to the Base Flood Elevation(BFE)in effect at the of the improvement. . • in-the case of additions, (e.g,new rooms,new wings or extensions)with no work to the'Dngianl structure except connection and access, only the improvement and not the unaltered part of the building would need to be elevated to the current BFE. If an • addition combined with•rehabilitation to the existing structure constitutes a substantial improvement,then both the original structure and the addition must be elevated. . „ Non-residential structures that are substantially improved in an A-zone may be either, elevated or floodproofa Floodprooft is not an option in a V zone, ` L Environment East, Inc. 2885 Indian Neck Lane P.O.Box 190 Peconic,New York 11958-0190 — - ---_ - 516-734-7474 Fax:516-734-5812 Rotert Residence; Permit#24928 Z Reydon Shores, Southold November 5, 1998 1`AP :. .. e ?erty Please find enclosed the revised and stamped plans for the Rotert house. We are scheduled for inspection next Tuesday November 10th. Thank-you And we will see you then, a= Sincerely; d a Joan Wilson i M-1802 BUILDING DEPT. INSPECTION [ FNDATION IST [ ] ROUGH PLBG. f FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: rS DATE INSPECTOR I M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] F NDATION 2ND [ INSULATION �[ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKSrY1z,44 . �C,411 DATE / o INSPECTO M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. ( ] FOUNDATION 2ND [ ] INSULATION [ FRAMING FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATEZO `S !6 INSPECTOR ` i 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO PLOG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: L- Al DATE j INSPECTOR '�' M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 LATION [ ] FRAMING [ FINA [ ] FIREPLACE A CHIMNEY REMARKS-. DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS LATION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECT BOARD OF NL'ALT11 . . . . . . . . . . . . . . . FORM NO. 1 .6 SETS ON PLANS . . . . . . . ... . . . . . . TOWN OF s0unioLU SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . ' TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOtll ioLn, N.Y. 11971 TEL: 765-1802 NOTIFY:73 /_?_ 7q CALL . . . . .vl. .� I;xanirbed..�.v/` 19.... l/ MAIL TO: . . . . . . . . . . . . . . . . . . : . Atgrrcrval.. l ., 19.... I'ennfl: tio. .......!. Q. ...........................;..... . 1)isapprovec a/' .. .. ................................... Building lnnpec:ror.. .... A .IC.A'r10N FOR BUILDING PE1tMi'f a( 0ate. MAS f. . .t5.. ,.,,19 iNslbalc•rloNs n. '1111a application mint be completely filled in by typewriter or in Ink and mAmitled 1.o, llre lAtilding 708pector,w 1 sets of plane, accurate plot plan to scale. Fee according to scicedule. b. Plot plan allowing location of lot and of buildings on premises, relationship to adjoining premises or pnblit'I streets or areas, noxi giving a detailed description of layout of property mint be drawn on the diagram wlblebr in"Ainrt,gf thin nigblicotioh. c. 'fire work covered by tills application rsy not be ccrosenced before issuance of Building Permit. `' d. Upas approval of this application, the Building inspector will issue a Building Permit 'tq the, applit;ant. . 'AwIl permit shall be.kept on the premises available for inspection thrauglhoot the work. e. No building scall be occupied or used in whole or in part for arty purpose whntever until-a Certificate of Occupancy shall lune been granted by Ube 1Arilding Inspector. , m'I.ICKfiO`1 IS 1C.MBY IIWE to the Building Department for the issuance of a Building Permit'ptirsnnt+to the, lUi.lding Tore Ordinance of the Town of Southold, Suffollf Canty, New York, and other applicable Laws, Ordinances or ReMkIations, for the construction of buildings, additions or alterations, or for removal or demolition, as Inerein c § to comply with all applicable Iowa, ordinances, building code, ihousing code, arld , r t r ;iced inspector's on premixes and in building for necessary inspections: �� 1;N V IRQNMENT.ERST.:INC ...................... JUN (Signature of applicant, or name, if a corporation) P.a...Box..1 go• RW.CnNS•C••N•:Y•::.......'... I TOWN OE BLDG.DEPTT I Quiling address of applicant) Slate whether applicant is owner, lessee, agent, architect, engineer,'getreral contractor, electrician, plurher or build, GENERAL CONTRACTOR .. .................................................... .......... .:... .... ................................. . Name of owner of premises ...........U�:!1S:`........... P: * r....(T....` 1J.!.Q�.rl�k�.��l.�............... (as an Line tax roll or latest deed) ®®®� IPand ation, signature of duly autlnrized officer. .......Betes..S,.•Stotabenburgh, Pres. title of corporate officer) Builders License No. 5 55 6-JU............... Plumbers License No. .................... . Electricians License No. ..................... Other Trade's License No. .................... I. Iocaticxh of land on haln{cir proposed �Vr�..ull��x�bc�l.....................�..(. , .�� ................•.• t`r 4J ......... tVE f� House Naber (0� SCreet llanlet 3 r County Tax Map No. 1000 Section .... ® .... Block .....©........ lot .....�. Subdivision ... ` •.S Q�E� . Filed Hap No. .��C.�. .... lot ... ....... (None) 2. State existing use arid occupancy of premises and intended use sad occupancy of /proposed-construction: a. Existing use and occupancy .... !.mile. ............0 ....t 4/ (li.. 1 6 l (� �.... _.. b. Intended use and occupancy .....�!�.j�1•�... >�, {.• ..• �, I � 1 [ uSndf 4404in a�pN Ylamss 3. Kiture of work (:aleck widdt applicable); Wew Building ........... Mlition ... ... Alteration ......... Repair ............ Renrxral ............. Darelitio ___ .... Other Work /,7 / o o (Description) 4. lintinatetl Coal ......y.................. fee ............................. ................. (to be paid on filing title application) 5. if (k+alligl, onber of doe111116 un to .......I.... Maher ofthwillingunits ;m elicit floor / /A� ................ If garage, uwnber of care ....... ..P.A A. If Ixnahneaa, camrercial or m(xed`occupancy, specify nature and extent of each Cypa of use..../.j t 7. Dimenalote of existing structures, If anyt Front... 32..... Rear :`�....... Depth t qq I- ..... .c I ,/ IkniglnC .........1.1............ Naber of Stories ...I.E..!......... Dhrenslons of sure tnteture with alterat one gr akliLione; Front ..,�B:..... Rear ...�.r�.r.�' /Y Ikplb .....tlji s. ...... Ilel�tc ...,1.. ............ Naber of Storles :..(.Y2i....... t / I/ ti. Dfseuslota of entire new construction; Front .. N'. ' hear ....•.1 ....... Depth 34-1 IleiglnC .....�.l.,Q............. Naber of Stories ..................... /� ............. 9. Size of lot: 1'rrml' .....(a.V.'.�....... near ..... ' ..... Dept'In `L.; 2- 1010. . Date of Rtrtlinse ..................... Mine of Pointer Ownner ........................................ II. Zane or use district In rAtidt promisee are situated , 7 12. Does proposed construction violate any zoning lar, ordinance or regulation; ....... �. . ND .......... , 1:3. Will lot Ile regraded ........(::©...... Will excess ,fill be reioved from preaivea; YES 14. N;n.es of Owner of prealses OE-AAJ Rn7�Z7- Mklreae ��� „��2r7fe�bu,r,`��X�r(/;�)rt'•e H,01e Wo. ......... Wynne of Arcl;Jtace .................................... "Yeas .. 5' ^V l' -7 — .•.•. ...... ....... Ilxxte No. .............. Name of Contractor Ettdir<)nmertt.•Ees♦r•Itne4.... Address .$..0.. .1.9Q.P.0l�PFl�r......17wne No.734„7474, 15. Is 11,16 pmperLy within 300 feet.of a t1dal t,*tiwxI7 * YI?S ...:...... NO 11 958 *IF YES. minKill) 7CMrt1 'IR115IM'3 l'ilml-l' NAY Be Rg(plim. .y . � s'r�i•1 l� �y FI.0'1' DIAGRAM locate clearly and distinctly all buildings, wAtetiter existing or proposed, and 19 •a ll se I, k It to ; frau properly linea. Give street and block number or descriptio; according to fleed, a' aCreet-now' s-'antl' Ij: .•e tAmiltfr Interior or corner lot, a ..+cxyaJ.vYLYM..YiM...N{MF}W.3 SCAM (Mr NiW Y(M;K, (Imam (Mr ..$LJffQ .1.t........... SS .............. er„S., Stoutenbu:F”...............Wing duly sworn, deposes and says that he in the nppti(ann: (lluna of Individual signing c(mtract) alxve unned, lie Im Lite ..Generdl..CAl6trACj;QX ....................... .............................................. (Contractor, agent,-corporate officer, etc.) of said (>vmmr or c miers, feel is dilly MiLhorized to Ixrfonn or hive perforned the said work antl to make a(xl fila This alry;licntitm; that all slaterents contained in this nliplicatitm are true to the heal of Ilia knowledge and Ixilief; end that the work will Ile perfonred in Lite urmner set forth in Lite appl.icatitm filed therewith. :bx)nl to te (re ne Chia , .. of ..:�.. .19.�- Notary .............. ... .... ... .. ...... (Signature of Appl.ltnnt) I UNDER WATER LAND 59.77 ry o`v ry h o ` n LOT I�Q/I alt' P� 7/ LOT 3 mar h P/vo QBy O oC zw1C h� -, 4S Lu ch C 00c o � f L. �,... jq Q � = -4v - � s � N. ?,4000,1001,1Z cd O' ry``'e-��•oos�r fP 1� �d'/2 LAN DRIVE SURVEY OF LOT 4 MAP OF RE- SUBDIVISION OF BLOCK 'F' CJ" OF MAP OFREYDON SHORE$ FILED OCT 7 , 1936 FILE NO. 1215 AT BAYVIEW TOWN OF SOUTHOLD ELEVATIONS AND CONTOUR LINES ARE SUFFOLK C OUNTY,N .Y. REFERENCED TO N.G.V,D. FLOOD ZONES FROM FIRM COMMUNTY.PANEL NUMBER 10 00 ' - 080 - 03 - 17 360813 0079 D SCALE I " 3 FEB. 16, 1998 �0E OF NFR ANY AC TEAA ICON OR AMMON TO TIRS SURVEY IS A VIOLATIQN S �oNN T MFrr OF Weil TA£AEN YORK STATE EDUCATION LAK . �m MEX TAS C M09-SUB,D/Vi M 2. ALL CemcArim Y :; A VAL�j FdVt W MAF ANO COMS rWWOF 0At Y F / N .s I�3 WP OASESgM TAE AFRESSED SEAL OF TME SURVEYOR IWSE MM TLRE AWWS lERE6NC 16ECOAUC E , P (5161 765 - 502 ADO/T1atlAl LY TO CQ Y A AL SAID Law THE TERM 'AL BY" P. 0. BOX 909 �-,f) �o. O� Mast�f usEo ar ANY AMD ALL vErORs uTpJZpJG AM 618 � Of ANO IR To iT A A T AV CQ�Iq AS HEE4AK souTNTHA D,VEN Y ND S�R�� UNDE Rk qTE� A ��e L Nb q E, 58.7. ' �/_.. " Pin ry or, 4 Z' Lo .•Orp '� Foo gg' aaJ tiw f g � Ob�A`1G Jam_ as A 00 - - Psy. � •� A� �-qy. l , N. Too v +ocy J 6 ^ Cl7 �o p pp, LAKE ==, LAryE DR/ VE DRIVE I SVR VEY OF LOT 4 MAP OF RE- SUBDIVISION OF BLOCK 'F' OF MAP OF REYDON SHORES " FILED OCT. 7 , 1936 FILE NO, 1215 AT SAYVIEW TOWN OF SOUTHOL D ELEVATIONS AND-CONTOUR LINES ARE SUFFOLK C AUNTY,N .Y. REFERENCED TO NAY.D. FLOOD ZONES FROM FIRM COMMUMTY.PANEL NUNOER 10010 ' - `080 - 08 17 360913 0079 D SCA L E 1 ° = 30 ' FEB. 8 qNY ACTMAT,WV OR ARA TO TlKs SURVEY IS A VIOLA7I0N. F n� 9 v Of 43GW 9 p�� TAK sTA76'SMAr LAW, 4 r.MatSfp/BgO�tpV C v PSAL C1 7 OKYroNS S. LIC. NO. 496/6 AS ftV,F RS Q1[SS�FD SEAL Of 71 SGRYOR E NlC OR C. W" niff TTr1ww�"�[[ "", r_WwL NTAM ALL ( l BO 7 0 TbDA Mr kDfi Av�iA LuR w 7> c�� p 49 R 7ET ' gs�ttn�-r� Plar��tt6$ .SH,NfL�: - I to PaoFrrJG FE;�r . Yy' cqc PI.�IwP• s{tE�lTtIrN Cc. F 'Lk10 �7ua 4f., 0c, flht'Z S. _ R- IS F�tTT INZUL 2ke� r . PANCAxe Rc%7F VEVIV 1 • ------��._..._--�L- 'r Zi UI NG TO HATct{ E-,.KI T; � Tt Vex PL`( l stflll'rtilNra+ L(o` P.C. ST?dcps R-19 U,rr wSUL , E.M16Z' IL.IY RM• );x1aT.i yy' Sf4E.t:•'t'R oC K ' • I \ T A Ph 1, FL. ' I 4;� 1 Rrb,•o•4. ' Y D/�` F�-Ywn. Sv6CL. PL..J OI.Si3 k j_- 2x to CCh SILL. FRISS• 3�Fd P M _ _ _ _ FMIST. KI tc+{E.S1 r RN4 i lE Si-i 1e�L-o Ire _ ArAc't4'lill $oc.TS ce' ri-G'?.ry,N. • - jiZ x UI 211 SLA. C C_ OTIC '�L• V./A4L- AQ 0C!'ZRwLs Act, STOPA6� 1 CL p"lCH EXi44T• $A'M Aow VC+NT I �x+sG DOOlx � W slpe t RbD wEraT s � I $xlSf.DOOR � ' n .� n Roo awl 70 ✓� g. . , r moi." ur sTD$AC6 CWpStT" I � - URDEmm iu , J 1 O 1 f� I Ni Q ' S I • `�7 b .i71'+;7'r1 . \./ �, L _:-. {' ,4 REQUIRED rl.R,.�• I Ex�s-ri-. �R�kGE. - _ oII 0 b° � d PROVIDE.OPENINGS FORAga EMERGENCY ESCAPE AS c PROVIDE / NR. FIRE REQUIRED BY PART. 7 RATED SEPARATION TO Hg A 1 N.Y. STATE BUILDING CODE. I PART. 717.3If) h) OF e-Ki cy � a APP OVEp AS NOTED OCCUPANCY OR '� N.Y. STATE BUILDING CODE. i Q DATE: B.RM � USE IS UNLAWFUL FEE: Br. USE CERTIFICATE Cvj;r cv 24. — - NOTIFY BUILDING DE AT OF OCCUPANCY 4 0 y2 2-"}98 A Dy z,• Z 7 +� p �'�' 4'-P y2 I 1 I 65-7807 FOR THE 8 AM 'RD 4. PROVIDE STOKE-DETECTING FOLLOWING INSPECTION& I. FOUNDATION - TWO RECILl ALARM DEVICES FOR POURED CONCRETE • STC lS��G• f'cDO L'I'[OL aq•'-pa (To AuGt-S wl F}XIsTEtOLK.[� �° 3'-O"l AST 2. ROUGH - FRAMING & PLUMBING D PARx nl.l moo ' d.,ppi-l-,Oy�t 3. ;NSULATICN '1 /J/®/,�%G�y�u2GCG�4✓ � � N.Y.S BUILDING CODE. 4. FINAL - CONSTRUCTION MUST L q BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET , THE REQUIREMENTS OF THE N.Y., STATE CONSTRUCTION & ENERi;Y COOES. NOT RESPONSIBLE FOR y� � '�•GP DESIGN OR CONSTRUCTION ERRORS ` IZEV, - 34'vt4 AllnLarcD ro1St. ifcoppartubing isused PLUMBER CERTIFICATION PLUMBER CERTIFICATION wl '40 RGl4I 1-0 .vxlsT. h}gUS � for water distributing ON LEAD CONTENT BEFORE ON gym; piping Shall be CERTIFICATE OF OCCUPANCY ERLEAD CONTENT BEFORE RDTERT D_ ,N EF • typM K or L onl CERTIFICATE OF OCCUPANCY A. PROVIDE ANTI-SCAIDAND/OR SOLDER USrD lR! IA!�TcR .c.�: t'n1i�1r' .P � aw.wN� JWC, SUPPLY ' 3 ;'' f l " SOLDER USED IN`WATER y�- ',I TNERMIIL SHOCK PREVENTING :i SUPPLY SYSTEM CANNOT =ASS, PART.902.1l F'" 'F D EXCEED 2/10 of 7% LEAD. M.Y.STATE BUILDING CODE PLUMBING r4 xsrR l C9''£'"I t-A U fL-il N /� y,.�r��*,a,,� IXUWWa NYYY611 ALL PLUMBING WASTE // �/ 7� E^ ��!I,I�C.'S't4 ` •'1G;•-7�I EAST- I f4C. &WATER LINES NEED (O / f1�Y{ poPf � tWE "' ,fv-Luo r FaulsT. GAel6 rST R t-44f— RspHn FI�sE, t Ass Sti 'N�Les P'T`A ` !f415 tt pro lk-aG Rrtj'T A C(�{1llt_E'i .��. "(D $E,, VN�xcgVh� • � oto EKIST. GFADE, f ITCti 'CO DPA NAGIE LVW staE Irxwta ; c M' U' {4t) `i Qtl" !t TA t L fecrit-46 TO 5' 0 . . R (( t., Bt vj D oE. • pjb C2AxM Mac .DF-, AOW GPADE j e 4 d i q t M � . �oTERT �� I ,D� NC� A SCALE: If BT."MOVED By: OBAWN � a _ � -yob t DATE: S. I Z V XEVIB[D "'+. 7L ORMWNO NUMB& Nvi �ort�rlFriT tts-t INC . , f-p i `ham •. A� A; 1 � 2.x8 �' Ih'•,.,� � ��� - -: 2xe of. CALLA I C� ile� GC S4PTbz — \ IILC _ E"'2>12 aWR _ I _ — __li. , _-- --- - - trl-T• _ — - - -I —_ — tl/ _--_ TSO C GWtDF /JA EP I Y ;Pi N f 0A SkL,L� I _4 I �155.. �:.F-M _ • _ .. /�j` -rte - --- -• � fT' I I U) Pll N i � r R_IS- r.lsu�, - FXIsT- '1"i&TH ! M TD LO vv iStDa I aT, I I l' �xlsi, Dc R ; / w R'101rysJt, LAUNDRY in � � GAp7s N a rr — I '•� I cy— I I C l N r ml 0 0� 6 9 7 :"I-} / - o.F� 3 erZ I. n r y IV PA,L TW `niPE..n '- � Tli'cX CLOt6P� < rte_ 34�'O„ (To Aur�� r(1 ex1�F °*r,�{1�t/ � �•�� �` i. Ir r, _ ij^1.'.0 lt�;l !CN �NL�,C'C �'• I.UN. 0 - - - -_ _ � _ ._. -' ' y Alai, SL 'G.DEPT. � l�LGk F. FUG4.u• ' o _�.-' �. ` - V:',r]� 'I _ JP SOUTHOIQ— '"' Ate,_ ', R�c.E. RM F . '{tE.v. 2,$,g9. �vv vM GRY RM. Aa;t„>;, / �7r: �'o . ��-�� J: Z M. CWINIDo V< DOOR P 1, I Oli AP VEO BY OR6WN BY JV\'�- Ll tAl N A9� SGLE' !/ INS1.= L , Ar l..;:C {:�.., _'•:-A''e:1- DATE: x(','24 , "5., ,�r` IpEvlseo 1�MM b