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HomeMy WebLinkAbout19427-z , s FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT O£fice of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22070 Date DECEMBER 29, 1992 THIS CERTIFIES that the building ONE-FAMILY DWELLING Location of Property 160 INLET VIEW EAST MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 100 Block 3 Lot I0.13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 27, 1990 pursuant to which Building Permit No. 19427-Z dated SEPTEMBER Z7, 1990 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 ONE-FAMILY DWELLING WITH AN ATTACHED GARAGE AND DECK AS APPLIED FOR. The certificate is issued to JOSEPH & NANCY POLICANO (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88 SO 11 DECEMBER 23, 1992 UNDERWRITERS CERTIFICATE N0. H 031041 SEPTEMBER 15 1992 PLUMBERS CERTIFICATION DATED SEPTEMBER 8, 1992 "l Buil ing Inspector Rev. 1/81 roses xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTWOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUS7 BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N ~ ~ ~ 7 , Z Date ....Z~ 7 19.,Q.:t? Permission is hereby grant toy:, ~ ..~A..... ..~~.f ...................~q..!.... at premises located at ...............................................0 ~1~...ry^!!G~~........................................................................... 5~~~ . County Tax Map No. 1000 Section .....,/...1~.. f~...... Black .....,.~......pLot No.....~~r..l.--~?.. pursuant to applicotion dated ............~(1.~ 19./....~ and approved by the Building Inspector. Fee S••%~•/a• ~ /9~7 a~c~ .~~'`~0 9~ ~~d~ g Bui n I for Rev. 6/30/80 a. Lh~e /~~~2 ~ Q F Form No. 6 Jc~/M1^~'~ U~ J TOWN OF SOUTHOLD J~ ~ BUILDING DEPARTMENT IC~'~L ~~~G°Z TOWN HALL SEII 1l (J°~~ 765-1so2 , ' y ~3 3~ra• C s , • c?~r , 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 2110 of 17 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. a For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: F 1. Accurate survey of property showing all property lines, streets, building and unusual natural ox 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 Che reasons therefor in writing to the applicant. ' 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 Euilding - $100.00 3. Copy of Certificate ,of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 S. Temporary Certificate of Occupancy - Residentiac~l 15/JQO, Commercial $15.00 Date j ~ 'ew Construction..../.. Old Or Pre-existin~g~B/u-il/ding ovation of Property:..~~F7d......~~~?...Y.:h:Y.•••~~~•~~•.•f?.~t~•~. ./.p•%:Z.~?.l.•... House No. Street Hamlet nwer or Owners of Property...~~..?../.U.~~4:~..••''.~~.~.~°~~!~.~.~!~ ~un[y Tax Map No 1000, Section.. d.......Block....~s:...........Lot...~~;.~~........... bdivision Fled Map............Lot. ~rmit No. J .Date Of Permit. /J®'/./. ,l. ....Applicant ~r~S~C/ .V~: !l ~c',~~~.~..... alth Dept. Approval ..........................Underwriters Approval......................... anning Board Approval quest for: Temporary Certificate........... Final CerticaCe.. . e Submitted: ~ L~~,~~ - APPLTCANT • ' INSPECTORS Victor Lessard Q 5~FF0(~-`~ Principal Building Inspector b© F, C®~ Curtis Horton F~ ~_-'ry' SCOTT L. HARRIS, Supervisor Senior Building Inspector o F ua ^t ~ y ~ Southold Town Hall Thomas Fisher v- C':~ P.O. Box 1179, 53095 Main Road Building Inspector ~ ~ - ~ Southold, New York 11971 Bui'lding Inslpectar ~'a~ Fax (516} 765-1823 Vincent R. Wieczorek Telephone (516) 765-1800 Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD SEPTEMBER 9, 1992 JOSEPH POLICANO 160 INLET VIEW EAST BO% 1742 MATTITOCR, NY 1!952 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) ffi No Underwriters Certificate on file.g`~'y The check is (outdatedlnot on file.)$25.00'"~-. ffi No Health Department Approval on file.b; No final inspection has been made. ffi No Plumber Solder Certificate on file (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 19427-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. i~~°~~ z THE NEW YORK BOARD OF FIRE UNDERWRITERS PA~~ ~ 8035340 BUREAU OF ELECTRIGITV 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date SNP'~F'AtRPk 19,:i..U9? Application No. on file 70S9.ty901U0 H 031.0+11 THIS CERTIFIES THAT only the electrical equipment as described hebw and introduced by the applicant named on the above opplication number in the premises of JUSt;PH PUi.17CANU, 1.60 TNGPT VxP~V! FAS'L', i'UT>@;A9.3f NAi'Y'TTUCK, H.Y. in thefoUoteinq location, ®Bosement ~ Ist F(. ? 2nd F'l. GAR I~17~' Section Block Lot ssaPr~otseR >®,1~s2 uas examined ort and found to been compliance with the reyuirementa yf this Roard. iIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT fWORESCENi OTHER AMT, K. W AMi. K W PMi K W. AMi K W AMi. H R as ~a 35 ~ ~ 3 DRYERS FURNACE MOTORS iUTURE APPLIANCE FEEDERS SPEOAI REC'PT i1ME HOCKS gEll UNIT HEATERS MULTI-OUTLET DIMMERS j SYSTEMS AMi. K. W. Oll H. P. GAS H. P. AMi NO. A W G AMi. AMP. AMT, AMPS TRANS. AMT. H. P. NO. OF FEET AMT. WAiiS 5 F 2 Z 6679 SERVICE DISCONNECT NO.OF $ E R V I C E AMl. AMP. TYPE METER 1 ~.4W 1 e 3W 9 %3W 3q 4W NO OF CC COND, A. W. G NO OF HPLEG A w' G NO OF NEUWAlS A W G. EQUIP. PER A' OF CC COND OF HbIEG OF NEVTRPI OTHER APPARATUS: aACU2zz-~ r>a~raasla-e l~.e. PANPI.90ARD5e1-2 CYk,. 50 G.C.('.Tc°9 SMUft6 DETF;CTOkc-1 -t''~"l JUSN£H POliLCANO G~~ 90 STkAS'StORD kUA.D W, RCl4PSTEAU, NY, 11552 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 NO7 BE ALTERED IN ANY MANNER. IcLD I1:SPEC;iUt7 ~~UATc. ~ COMMENTS ro / ~ 1 . ' '1 ~ ~ _A H ~,ll~ H FOUNDATION ~ ('~st) ` - _ C~~l m FOUNDATION (2nd) ~ 2. o / O P.OUGH FRAME _ -PLUMBING/ C y H i 3 . ~ ~ ~(1 H IIJSULATION PER N. Y. STATE ENERGY , CODE 0 4 . FINAL ~ o z p ~ . AD TIONAL COMMENT x S-- ~ ~ ~ `6` r m ~ 9 ~ ~ H 9 „ H ; Z~ E` o 2 ~ ~ !7 I*1 • ~ r b 1 b H 6 I MAR 131992 f° ~9~ph 1'o9ieano ` ~ 90 STRATFORD ROAD Towiv a~~ : IF~~. WEST HEMPSTEAD, NEW YORK ]1552 PHONE: (516) 292-1669 a ~ ,lJ,~tl ~~~0~~ v~y ~ ~y~ ~ ~~FFOCK~®~ FRANK A. KUJAWSK[, JR., President c ~ ALBERT J. KRUPSKI, JR., Vice-President cn l~j TELEPHONE JOHN M. BREDEMEYER, III ~ ® ~ (616) 765-1692 HENRY P. SMITHKI JR ~'J®1 .~1a®~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD D m ~ Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 94Da pE August 30, 1988 70WN pF SOU1}1 p Mr. Joseph Policano 90 Stratford Road West Hempstead, New York 11552 Re: 1000-3-10.013 Dear Mr. Policano: The following action was taken by the Board of Town Trustees during their regular meeting held on August 25, 1988 regarding the above referenced property: WHEREAS Joseph Policano applied to the Town Trustees to clear on property located at Harborview & Inlet-View East, Mattituck; property is identified on the Suffolk County Tax Map as 1000-3-10.013, and WHEREAS the Town Trustees have personally viewed and are familiar with the request of the applicant to clear on said property, and WHEREAS the Southold Town Conservation Advisory Council has , recommended approval of a waiver as requested, NOW THEREFORE BE IT RESOLVED that the Southold Town Trustees approve the request made by Joseph Policano for a waiver to clear on property within 75' of wetlands, property is located on Harborview & Inlet View East, Mattituck. This approval is subject to the following: 1. Clearing within this area is to be done by hand. 2. There is to be no disturbance to the root system of any trees in this area. 3. There is to be no use of fertilizers in this area. 4. This approval is subject to any other agency or departments approval that may be applicable. Please return to the Building Dept. for a determination on the need of any other permits that may be required for this project. i i Veryy truly/yours, / I, Frank A. Kujawski, Jr. ~ President Board of Town Trustees FAK :1p i ~ ~ e-w~ , ~ a ec: Bldq. Dept. ~ ?;,,,;~,1." 'r 4 file ~i ~ ~ ;{.•3 ..,,,":rt.,~,Z~ ~C~anwv~r,~,,,..~ III I, i I ~I I , i Ili i II ~I i _ - q~~EFOI~c® VICTOR LESSARD ~ EXECUTIVE ADMINISTRATOR ~s~ ~ ~ TOWn IIa]], 53095 Main Road ~slb] 7es-ISOZ ~ ~`c P.O. Box 1179 ~1 ~°'a Southold, New York 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD DATE: August 22, 1988 Dear Mr. & Mrs. Joseph Policano: In order to issue a Building Permit for your proposed construction, for buildings located on lots adjacent to tidal water bodies, we will need a det- ermination by the Board of Town Trustees and a waiver of jurisdiction or a permit from New York State Dep- artment of Environmental Conservation. Yours truly, Buildi g Iey;;'pector Phone ~ of D.E.C. 751-7900 phone 6 of Town Trustees 765-1892 ~)E@~u~`FdkoStt~~eA4f@~~~@~i~ i0. ~~~tJ?mgdtal ~gj}5ervalion Room 219, Stony' Brook, NY 11799 `=~PWr~~•7 ~ U~ ~Cj Wl'1?11"1 ~ '~u cl2 ~.o ~ Henry G. Williams .~ln M4 + U 1 ~kcJ E¢e ~ f Commissioner )'LV~ ~ u~p"Z Dear Lot l3 ..~kl..ef ~r ~sin~s A review has been made of your proposal to: ('wis{~rkc~- ~ sr~51~-r' Fc,wi(~ ~fw~eflre+oJ ci ~~c@ tk sful/ Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that the parcel project is: Greater than 300' from.inventoried tidal wetlands. Landward of a substantial man-made structure greater than I00' in length which was constructed prior to 9/20/77. x)C)( Landward of the 10' above mean sea level elevation contour on a gradual, natural slope. Landward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. Listed in Part 661.5 of 6NYCRR (Tidal Wetlands Land Use Regulations) as a use not requiring a pei;niL o: nctifcation latter of. approval. Therefore, no permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conservation Law). Please be advised, hoorever, that no construction, sedimentation or disturbance of any kind may take place seaward of the 10' contour or topographic crest without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation in this area as a result of your project. Such precautions may include providing adequate work area between the 10' contour or topographic crest and the project (i.e. a 15' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. Please note that any additional work, or modification to the project as described, may require authorization by this'Department. Please contact this office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other ,agencies. Very truly yours, t ~~f ~7~~ DepuKy Regional Permit Administrator r~Nr 765-1802 /~l9 vs~ dU1LDING DEPT. ~1 ~ ~ ~NSPE~T'oN [ ]FOUNDATION 1ST ( ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKSa ~ ~ c~lw1~.~- ry J DATE ~ ot~ INSPECTOR ~ ` BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST ( ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ )FINAL REMARKS: l~/~ a~ . DATE ~ ~~INSPECTOR ~2.Z~ I l ~ ~ ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T (~'J ROUGH PLBG. [ ]FOUNDATION 2ND [ INSULATION [~RAMING [ ]FINAL REMARKS: G~~ DATE ~ INSPECTOR a f 7 GJ 765-1802 ~~'`'`T~~ //BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ RO~UGH~ P~.BG. [ ]FOUNDATION 2ND [ ] INSULAT-I~O..N~~ [ ]FRAMING [ ]FINAL REMARKS: ~ /U®l ~~~~a !'~L(~ - .__~L__'"''"~"_ _ ~ - ~7 DATE ~ ( ~ INSPECTOR i 1 ~s`~9 7G5-1802 BW4DING DEPT. INSPECTIOIN. [ ] F UNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE / INSPECTOR _ i~~o~ ass-iso2 BUILDING DEPT. INSPECTION [FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL i REMARKS: __'~a .Yn ,~2.2-.~ r t E s ~_r_._,. 's DATE INSPECTOR i s ~ _ _ , , Foaas xo. s 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) Nfl 0171t~9 Z Oote ...g..'..~~ 19.A..~ Permission is hereby granted ......lr.~f,~'~~~ at premises located at .,ls!?.......... ~iac-{'~l~l:Pr..~..~.....~a~ ~~f"~, ..y1..1... County Tax Map No. 1000 Section Block ...............3. Lot No....,~~.~.~.-~~.... pursuont to application dated ..............~,.1..~.~............................., 19.~Ar.~., and approved by the Building~/Inspector. / Fee ing Inspector Rev. 6/30/60 . d _ _ , . . 3. Nature of work (check which applicable): New Building Addition Alteration . Repair Removal Demolition Other Work . _ (Description) 4. Estimated Cost .........~.~j.0.t2.v Fee . (to be paid on filing this application) If aralling, number of dwelling units . ~ Number of dwelling units on each floor e^:~-, • , • • , • If gwege, number of cars C"tt/t,5' ` 6. If;business, commercial or mixed occupancy, specify na$ur nd extent of each t p use r. . 7. Dimensions of a is ing structures, if any: Front Rear ,,2' Depth ..~,t~.--~. . $eight .....Number of Stories ...........d~"~-~- . Dimensi s a tructure with alterations or additions: Front Rear . 'Depth .......................Height ,........:.....Number of Stories . 8l Dimensions of entire new construction: Front Rear Depth . ITeight Number of Stories , . , w...... . 9. Size of lot: Front ~~.U . Rear /.02 , , , , Depth ~/a 7~..~-"' 10. Date of Purchase .............................Name of Former Owner . 1 I. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation: C . 13. Will lot be regraded / ..Will excess fill be remov d o premises: _ Yes No 14. Name of Owner of pre ses . J~4Y~!l...119. !S~^'.~Addtess .~:a hone Nos~~~?5.'21.~. Name of Architect ...........................Address , ................Phone No............... . Name of Contractor ..........................Address ...................Phone No............:.. . PLOT DIAGRAM Locate cleazly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. f l/ ,ate ~ STATE OF NEW S.S CO TY OF . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ove named. j 1 He is the ..............v.`:~. "^:\.....~~~2~/G~~~tr~............................................ (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 m/e this ~~-p~ ............l.Q.:~.\ . ay~~.LL'.GG. 19.df~ Notary Publi C%~~~ c,~~l~~~. mar/..-.1~~~. County a Nola P D~ T TERRY ry ublic, State of Now York ' ' • • • • • • • • • tluetlfieoal6n gu dkBCuun ~ (Signarure of applicant) Commission Expiras May 31, i BOARD OF HEALTH 3 SETS OF PJIANS FORM NO. 1 SURVEY v . TOWN OF SOUTHOLD CHECK I~.~[ . BUILDING DEPARTMENT SEPTIC FORM . ' TOWN HALL ~jJd ~~/lgclla/~ SOUTHOLD, N.Y. 11971 NOTI~ 0~^5 ~j~,j~ TEL.: 765-1802 ALL- L ! 1 y z- IS EXamin~d . ~ 19~.. Approved ...g/! Z......, 19 Permit No. ~7?~©~.j~ Disapproved a/c I. . /o~-a"g_ 00'3.9 • • • ~ TOWN U SOIfTNOLD (Bu' ing In ector) ~P~ ion APPLICATION FOR BUILDING PERPIIIT i Date , O g... 19 .4~_~ I INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building 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 streets or areas, and giving a-detailed descript{on of layout of property must be drawn on the diagram which is part of this appli- cation. I 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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department, for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Tow1i 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 de olition, as herein described. The applicant agrees to comply withjall applicable laws, ordinances, building code, housi de, and regulations, and to 'es and in building for necessary ' spections. , admit authorized inspectors on premisi G/ / . . Sign re of applicant,, or name, iif a corporanon) i ~ ;5.! (~'.~i• •t~'o/d,l~...RcY,, ,l(,o/~E'd~+~°sTrrs~,7~lY (Mailing address of applicant) ~~~5~-./ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...........b !:~.N t A / . Name of owner of premises ...~?°is~j°.~'i••••~a~l~'~•~~••••• /y~l•~~~•••.d~K~~v,,,,,,,,, (as on the tax roll or latest de ) If applicant is a corporation, signatuXe of duly authorized officer. (Name and title of corporate officer) ~ 'j,~ Builder's License No. ~ . • . • ..~~zp/ / fiC Plumber's LicenseNo~n~.~.. ~°OI~•r.Ql~~2 Electrician's License No~~n.F2• . (°O,/VT~~p/~.' Other Trade's License No . . 1. Location of land on which proposed work will be done . . . Count NTax Ma No. 1000 See~~ ~~t ~ Hamlet Y P #ion #(ado ;~oU•-o3• /4 Block ~ ~D~~~. Lot... Subdivision ~JS!~C.~ K ~LR~• • ~l~S~ •~•~~'~TY',~... Filed Map No . Lot ~ , . (Name} 2. State exis~ng use and ocpcup ~ cy of premises and intende us and occupancy of proposed construction: a. Existin use and occu anc • • • • • . t~. , ~ • b,Intendeduseandoccupancy'i •'~`'r"°••~•••1""••••••••••••• • ~ i / ~ ~ >O Oi p' N /0 / F 5TA'E OF N'EW YbRK.~ ~ - Y +K aC; -'@b,Ofi Of ShL7 MAP311'~~=.,,,, ...1- O. v _ ~,pl.~d, wrr p " ~ , o SD ~ ~ ~ ~ m ~ o w~ m ~ W ~ ~ "~~o° N-o_ ~ ~ o v'° Q~. m ~ ~ '~~mS Q!, ro ~ n g a ~ ~ \ ~ y v _ n C yr S ~ ~ ~~.R"b r ~ 4 N ~ ' ~N. p' O'' W ~ g n 3, ~ o v ~ ~ ~ , 20.5 9 < N t ~s, zi •t ~ r R1 p M . > T # H o~ ~ ~ ~ x ~ ~ ~ ~ ~ ~ ~ 4i ~ _ s w o q .D m , a In a n , ~ p ~ a r ~ ~ ~ ~ ~ ~ m x _ `c5' . o ~ ~ ~ , ~ a ~ f.,.~,~,~~ ~ ~ ~ r ~ 4, a 3 yr a ~ ro ~ ~ " w ~ - ~ 2 p M. ~T" ~ as - ~-r - ro ¢ CC! o ° ~ .A~,~ ~ ~i'~ a, - QQ ` ti, . ~ ~ ~ QOM ~ `~i _ ~ a,oa,~,- m ~tt;'S ~ - ~ r ~ °Ne ~ ? ~ - ~ t c!~'ka ~ 4 S'1 ~ ~ ~ ~ ° v~R Leo, t ~ ~ f m, 7~ " _;'a ~11'.~' Q " Tt .G° ~ ~ S -t- ~ i '~1 Di .S.iS C~ Q ~Q (~l ~ C7 ifl ~ ~v! rn i ~ ~ ' ~ Q 'n b,~ .r~„ m n> - „ m X ~ ua ~ 1 ~ ~ ~ k A _ ~ W' ~ ~ ~ ~ = - ~ ~ ~ on~'~'~' cif°~a 2 v.~ O~tA. %Y ~ Y ° '.5 N/ 0/ F STATE O F NEW Y O R K O ~ _ r;~ ~ `S,,F~ ~ 1 ~ ~ EDGE OF SALT MAR 3N~'~ ~ " ~"t"r ~ RF' ..O 2 j. 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N.Y. ! 19?1 ~ ;'y i i C E R T I F I C A T I O N - 4 `.f , ~ , . . pate e -f~.~ f3~c ~ g c~ 111, i Building Permit N~~o.-_~~'Z { Awnex _~A___S~U~i_^y~~.IG~, nt D l i lea9~e print) ; nn plwaberF3F,ersAa~7 /'Lum/.3/.Jb ~ rcJEA'+//?G ' (please print) I certify that the Bolder used in the water' Supply ~kyi(~rA~IB ~ ~ , ,M' contains less than Z/10 of i~ lead. pltawger' 93 signak~v{ Sworn to before 911e this gC~ day of ~F/~TemF.vEr2 e ~ , 19 9a Notary P~tlilio Notary Publleo ~u r-coy-~ 9yonnty ' EILEEN M. ROACH£ Notary Public, State of New York No. 4826842 Qualified in SuKolk County ' Commission Expires Jnnuary39, 98~` .