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Home My WebLink About50926-Z - TOWN OF SOUTHOLD BUILDING DEPARTMENT ff `` TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 50926 Date: 7/10/2024 Permission is hereby granted to: Peconic Coastal Pro LLC PO BOX 645 Southold, NY 11971 To: Modification to existing wireless communication tower: AT&T Wireless: including removal of(1) antenna platform mount, (6) antennas and (12) RRUs; relocate (3) existing antennas to (3) new antenna sector mounts and add (9) new antennas, (2) OVPs, and (12) RRUs, as applied for, and per Planning Board approval & conditions. At premises located at: 415 Eli'ahs Ln, Mattituck SCTM # 473889 Sec/Block/Lot# 108.4-11.3 Pursuant to application dated _ 5/10/2024 and approved by the Building Inspector.. To expire on 1/9/2026. Fees: WIRELESS COMMUNICATIONS -MODIFICATIONS $500.00 CO-COMMERCIAL $100.00 Total: $600.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 W Telephone (631) 765-1802 Fax (631) 765-9502 htt ://www. outholdtowmi . uv Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only a .. PERMIT NO, � Building Inspectarr Pl' � Q 2�124 PVr� Applications and forms must be filled out in their entirety.Incomplete e„ applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: William J Baxter , l:c 100, 00-0400-011003 Name: S Project Address:415 Elijah's Lane Mattituck, NY 11952 Phone#:203-637-4559 Email:wbaxter@baxterinvestment.com Mailing Address:4995 Nassau Point Road, Cutchogue, NY11935 CONTACT PERSON: Name:Allison Conwell - Agent for AT&T Mailing Address:750 W. Center St. Ste 301 W. Bridgewater, MA 02379 Phone#:215-588-7035 Email:aconwell@clinellc.com DESIGN PROFESSIONAL INFORMATION: Name:KMB Design Group Mailing Address: 1800 Route 34 Ste 209 Wall, NJ 07719 Phone#:732-280-5623 Email:tmazur@kmbdg.com CONTRACTOR INFORMATION: Name:United Network Communications Mailing Address:262 Hudson St. Hackensack, NJ 07601 Phone#:347-398-0600 Email:a.arroyo@unitednetworkcomm.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition INAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $50,000 Will the lot be re-graded? ❑Yes ANo Will excess fill be removed from premises? ❑Yes R'No 1 PROPERTY INFORMATION Existing use of property:Telecom Intended use of property:Telecom Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to 440 this property? ❑Yes BNo IF YES, PROVIDE A COPY. R Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized Inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name):Allison COnWell - Agent for AT&T ®Authorized Agent Downer Signature of Applicant: Date: 3/27/2024 STATE OF NEW YORK) SS:�+ COUNTYOF ,455 1)) �� G G�^� ►/,J TC being duly sworn, deposes and says that (s)he is the applicant Name of individual signing nin g g contract) above named, (S)he is the, V-PIF - ....... ..................... (Contracto A e , orporate 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/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith„ Sworn before me this *' tt l� day of Ft Z0 h /C Notary Pdb�c;"fir y cw.. PROPERTY OWNER AUTHORIZATION P'"'ff I.EUNd.tl9l.N9%4A1 (Where the applicant is not the owner) - I, v,T 4- residing at � ��A �41 G"� 00 do hereby authorize LOS 6P) ;, d it f ,�Y to apply on my behalf to the Town of Southold Building Department for approval as described herein. Ownerrs Signature Date Print Owner's Name 2 TOWN OF SOUTHOLD COUNTY OF SUFFOLK: STATE OF NEW YORK --------- ----------------------- ----------µ------------- ----_--_------------X In the Matter of the Application of New Cingular Wireless PCS, LLC : AUTHORIZATION OF OWNER At the premises: 415 Elijah's Lane Mattituck,NY Section 108, Block 4, Lot 11.3 ----....------- ---------------.._-----.._-------------.---------_------- ------ --x STATE OF NEW YORK ) ) SS.. COUNTY OF SUFFOLKOL - �a4l , r ) o ' i being duly sworn, deposes and says: I am the owner in fee of the premises known as Section 108, Block 4, Lot 11.3 (the "Premises" hereafter), and do hereby authorize New Cingular Wireless, PCS, LLC ('AT&T' hereafter), and its representatives to bring such applications for municipal approvals as may be necessary for modification of its public utility wireless telecommunication facility on the Premises. As such, I will fully cooperate with AT&T and its agents in obtaining any required Approvals. Y 20.24 Sworn to before me this day of , ------------ NOTARY PUBLIC J s �rF' 4ltl gd11111 h41k�N�� Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) SBA Towers IX, LLC,as Attorney In Fact for Grantor, J,p��onjc Cqa�t�j Prqp!!r�ies LLC residing at _8051 Congress Avenue (Print properly owner's name) (Mailing Address) do hereby authorize Pat O'Rourke-Agent for AT&T Boca-Ratan,f-"3487-1 07 ...... (Agent) ww to apply on my behalf to the Southold Building Department. 2 WDZIAr r Kl--S-�7�10X- ature) (Date) Jason Silberstein, Executive Vice President,Site Leasing (Print Owner's Name) OFFICE LOCATION: r� MAII.ING ADDRESS: Town Hall Annex s P.O.Box 1179 54375 State Route 25 ��*"�� ? a,n Southold,NY 11971 (cor.Main Rd.&Youngs Ave.) Southold, NY Telephone: 631 765-1935 www.southoldtownny.gov FID4 „# J U L 10 202A -0 PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: Michael J. Verity, Chief Building Inspector From: Heather M. Lanza, AICP, Planning Director �C Date: July 10, 2024 Re: Planning Department Report Proposed New Cingular Wireless (AT&T) Upgrades @ Baxter Located at 415 Elijahs Lane, Mattituck SCTM#1000-108.-4-11.3 Zoning District: LB The Planning Department has conducted a review of the proposed modifications referenced above pursuant to §280-74 B(2), and has received a report from our Wireless Technical Consultant, Cityscape, Inc. (see attached report dated July 1, 2024.) The proposed AT&T equipment upgrade is in compliance with the General Requirements of§280-70. In addition, this proposed equipment upgrade complies with §280-71 (A)(2)(b) as it causes essentially no visible change to the exterior and the base station equipment conforms with §280-71(A)(2)(a)[2]. Therefore, we recommend a Building Permit be issued for this application as soon as possible to meet the Federal shot clock rules for approvals of modifications to wireless facilities. Laserfiche File: Planning Department\Applications\Site Plans (SP)\Pending\1000-108-4- 11.3 Wireless Facility at Baxter\Upgrades\1000-108.-4-11.3 Thank you for your cooperation. cc: Patrick O'Rourke, Centerline Cmmunications Town of Southold, New York vkyScape C O \ S ll L T A , T S . I N C Telecommunications Site Review 2423 S.Orange Ave#317 Modification Application Tel:877.438.2851Orlando Fax:877 220 4593 July 1, 2024 Mara Cerezo, Planner Town of Southold Annex Building 54375 Main Road Southold,NY 11971 PROVIDER/ID/NAME: AT&T/NYNYNY0228 /Mattituck TOWER OWNER/ID/NAME: Crown Castle/BU#843211/Mattituck ADDRESS: 415 Elijahs Lane,Mattituck, Suffolk County,NY 11952 LATITUDE: 40° 59' 57.79"N LONGITUDE: -72°30' 40.17"W SCTM#: 1000-108_4-11.3 Dear Ms. Cerezo, At your request, on behalf of the Town of Southold("the Town"),CityScape Consultants, Inc. ("CityScape"),in its capacity as telecommunications consultant for the Town,has considered the merits of the above-referenced application submitted on behalf of AT&T Mobility ("Applicant") to modify its equipment on an existing one hundred seven foot, six-inch (107' 6") monopole tower (115' 6" at top of highest appurtenance). The tower is owned by Crown Castle and located at 415 Elijahs Lane, Mattituck, Suffolk County,NY 11952,see Figure 1. t Structure& E ui ment Per the submitted construction drawings(CDs)1 the Applicant proposes to remove one(1) antenna platform mount(Site Pro 1 #VFA12-HD-NPNH), six(6)antennas and twelve(12)remote radio units (RRUs), relocate three (3) existing antennas to three (3) new antenna sector mounts and add nine(9) antennas, two (2)over-voltage protection(OVP) devices and twelve (12) remote radio head units (RRUs), as detailed in the table below. All work will be done at the ninety-eight (98)foot(centerline of the antennas) elevation of the tower,see Figures 2 and 3. TOWER MOUNTED EQUIPMENT # FINAL Co nfiguration 12 Antennas:3)Commscope NNH4-65A-R6H4;3)Commscope NNHH-65A-R4; 3)Ericsson AIR 6419 677D;3,)Ericsson AIR 6419 B77G 12 RRUs:3)Ericsson 4478 B14;3)Ericsson 4490HP B5 B12A;3)Ericsson 4890HP 62/B255 B66;3)Ericsson RRUS 4415 B30 2 OVPs:Ravcap DC6-48-60-18-8F 20 Cables:12)1-5/8"coax;4)7/8"DC; 2)3/4" 18P Fiber;2)#6 AWG DC ..................... CDs prepared by KMB Design Group Rev 0,"Issued for Permit Filing"dated 04/09/24,signed and sealed by a New York registered Professional Engineer_ Town of Southold—SCTM#1000-108.-4-11.3 AT&T/NYNYNY0228 Page 2 C O N S U Also proposed are the installation of two (2) #6 AWG DC cables to connect the tower mounted equipment to the ground equipment.All other ground work is minimal and any equipment connections will take place within existing cabinets in the existing lease area,see Figure 4. Structural Analysis The Applicant submitted a Structural Analysis Report prepared by Tower Engineering Professionals, dated April 4, 2024. The report used TIA-222-H, Risk Category II and Exposure Category C standards and concluded,the tower and its foundation have sufficient capacity to carry the existing and proposed load configuration without modification. The max structure rating is 91.8%out of an allowable 105%which is determined to be structurally compliant, see Figure 5. With new replacement antenna sector mounts to be installed on the tower, The Applicant submitted a Mount Structural Analysis Report prepared by KMB Design Group, dated March 21, 2024. The report used TIA-222-H, Risk Category II and Exposure Category C standards and concluded the proposed antenna sector mounts have sufficient capacity to support the proposed equipment mounted to them with a maximum structural rating of 63.7%,see Figure 6. RF E; posur1 To verify RF exposure safety, a Radio Frequency-Eletromagnetic Energy (RF-EME) Compliance Report,prepared by Centerline,dated June 12,2024 was submitted,see Figure 7. The report is an analysis of the predicted RF exposure levels of the existing providers on the tower. This analysis takes into account the RF effects of the Applicant's (AT&T) along with T-Mobile, Dish Wireless and Verizon Wireless showing existing antenna operations at the site.At street level, at the site,the maximum composite RF calculations are 9.87%of the FCC general population MPE limit which is well below the allowable limit for compliance. Sumtng -�[�aa Lovaal "er:otntaaen4e-l CityScape verified this application to be an eligible facilities request and meets the definition of a non-substantial change ("substantial change" being defined in 47 CFR §1.6100(b)(7)of the FCC Rules). Therefore, this application qualifies for streamlined processing at staff level under 47 CFR §1.6100(c)and CityScape recommends approval of the application. Town of Southold—SCTM#1000-108.-4-11.3 AT&T/NYNYNY0228 %;"Scavjp� Page 3 C ® N s u L T A N r S I N C I certify that, to the best of my knowledge, all the information included herein is accurate at the time of this report. Cityscape only works for public entities and has unbiased opinions.All reviews are based on technical merit without prejudice per prevailing laws and codes. Regarding the structural analysis reports, Cityscape verified that the proposed appurtenances shown by Applicant's construction drawings were listed in the structural reports,but did not independently verify the calculations,statements or the appropriateness of the analysis criteria contained therein. Town staff should verify compliance with applicable building and fire codes prior to issuance of a permit for this modification. Respectfully submitted, Steve Webster Project Engineer Cityscape Consultants, Inc. Town of Southold—SCTM#1000-108.-4-113Ckyscaw AT&T/NYNYNY0228 Page 4 C O N S U L T A N T s 1 N C x d,� UICK rgue or "'North Fork Country Club Pd P: NCT cove Y'v"'hY Chub Inc r NewSulfo*,% a;mpu New Suliox Aye AaN��t6ku�k Pws�`io'xAVe New Suffolk KEY MAP �w SITE LOOATION l C i I1 � Owl /l; � �gr r l �%/ l01l�d 71x17 SC _. ...,. . .. _ ..��AL@:1"�Z00' 24x3B SCALE.-_ �'�700._.' , Figure 1-Site Location Maps Town of Southold—SCTM#1000-108.4-11.3 AT&T/NYNYNY0228 %Mftysca*pl� Page 5 C O N S U L -PROPOSED AT&T ARTDMA PPE MWNTED TO NEW ANTDMA MO1MT M1 i... (VP OF J.1 PER SECTOR) ppfl V*. pOSTMO RELOCAIR,D AT&T DC7 f7OsnNc RELOCATED AT&T ANMWA k PIPE S101RDm TD MW ANIDMA MOUNT(TYP OF D.1 PER SECTOR) n (_ PA0P0$M MAT RAR'd M*A MITD ... ,. • Y TO NEW BACK To BACK N'OUNT MP OF 12.4 PER SECTOR) 4 —PROPOSED AT&T(2)ANIFNNAS(STACKED) Y PFE MOUNTED TO NEW ANTDMA MOUNT (TYP OF 1 1 PER SECTOR) _.. I.M 'ExY^TTtC REY,OCATM AE4kT CM ANTINNA 7 � Q �Y r PROPOSED AT&T(2)15 O OC POKER .., TRIUNKS EXIS NSiOE MONOPOLE 70 F u.. FOLLOW Nc u W � W s .. yyy Lir i n s 1 Figure 2—Elevation Drawing of Structure Town of Southold—SCTM#1000-108.-4-11.3 AT&T/NYNYNY0228 Page 6 CON S U LTA 1 T S , t NC ~ WSTM6 Wpp[citb bSPo "NDw® 1 she "w6'iv.N1v¢:L rrNY A.PoVIXcnw irA..... v.,m. — ,Aywt�bm •ur' mswr wx mn"s�r�mww. T 0 u8 rT rn w . d rr.fin a c it tia w, �� Ay {R4t 1} qT (W y.r inti wUm 1 t ��14 F M� , � w_ •,MX Irw:N'1 MYY'�.. "' f✓r Ipun tt� m "Yww' � •}k!(])YB1DNr£ uP a B(aa anwl ry tff�Vti!}p IBp1A[L LLS(HG dp' wmGB^(V�L"aT�!fnY 5��.: IPn�IYN dr 1 A V(iA YCrOY( �� — -0AW 6 it i pi31K xF<a®IPD a!®A YCltpf w �nnnnr"w ^t�x.rx r ♦arrwu t '9il$YVM011.kiY7")iW kAM JALL.%%4TO"l 7 PIWCOOMfi.WWTV41Chol."WAL.a9ZGFw"I u ew x�wx.r."� rn.'xi Wst(oi^•+u, r..wr.�,rvB+nw ir,M1m�l�M�aBa ,,...,,,.,.�,.,, .,® ..—_ Figure 3—Existing and Proposed Antenna Configuration Town of Southold-SCTM#1000-108-4-11.3 AT&T/NYNYNY0228 ckyscape Pagel CONSULT ANTS . I N C y fi ,i�a��ar�i�w�arvsv�a + e s M1fi4 d fi,� I � •,.'�MtgN#55E�Y'�t'N.NO�'AME7YT� Figure 4—Existing and Proposed Ground Configuration Aft Town of Southold—SCTM#1000-108.-4-11.3 AT&T/NYNYNY0228 coNsuL TA N •rs . iNc Page Date: April 4,2024 / Tower Engineering Professionals 326 Tryon Road Raleigh.NC 27603 (919)661-6351 Subject: Structural Analysis Report Carrier Designation: AT&T Mobility Co-Locate Site Number: NYNYNY0228 Site Name: Mattituck FA Number: 10075046 Crown Castle Designation: BU Number: 843211 Site Name: Mattituck JDE Job Number: 2111277 Work Order Number: 2292649 Order Number: 666253 Rev.0 Engineering Firm Designation: TEP Project Number: 218919.944929 Site Data: 41SE1NjAbs LAr ,M4tl'It4c4, uffolX t:Plunty,NY 11952 Latitude 401 9"57.79",Longitude-72"30'4t 17" 107.5 Foot-Monopole Tower Tower Engineering Professionals is pleased to submit this "Structural Analysis Report" to determine the structural integrity of the above-mentioned lower. The purpose of the analysis is to determine acceptability of the lower stress level.Based on our analysis we have determined the tower stress level for the structure and foundation,under the following load case,to be: LC7:Proposed Equipment Configuration Sufficient Capacity This analysis utilizes an ultimate 3-second gust wind speed of 128 mph as required by the 2020 New York State Uniform Code.Applicable Standard references and design criteria are listed in Section 2-Analysis Criteria. Structural analysis prepared by: VT/SW r r Respectfully submitted by: H dr dr Adam N.Howe,P.E. 1069 SSI 4-4-2024 Figure 5—Structural Analysis Cover Page Town of Southold—SCTM#1000-108:4-11.3 clty �" *%Aft AT&T/NYNYNY0228 Page 9 CON S U LTA N T S . 1 NC ---------------- ::a;,,,6 twaiaa March 21.2024 New Cingular Wireless PCS.LLC(d.b,a AT&T) 1425 US H\\'Y 206.Suite�NX04A Bedminster,NJ 07921 RE: Antenna Mount Analysis-Tower Mount Site Name: Mattituck FA Number: 10075046 I1V114 Number: R'SNYJ0044971 Site Number: NYNYNY0223 Pace Number: MRNYJ042074 PIN Number: 2191 A 19YGJ Scope of\York: E-S\VAP Site Address: 41 4;Elijalt's Lane Mattituck,NY 1 l9?2.Suffolk County Latitude:N 40'59'?S.1"(NAD 83)Longitude:11'72°30'40.2"(NAD 33) Mount, Site Pro VFA l2-HD-NPNH Sector Frame with dual tic-back,(3)2-1 2" diameter pipe masts and Sabre C 10899055 collar bracket 101B Number: 331.3111.AF8 A,%La Result: 63.72%-Passing(New Mount) To Whom It Nlaw C'oncem: Kj\4B T)esiell Group was requested tea subunit tlus"Arillomna Moum Analvsas"to determine the mnictural nateerily of the above-mentawaned lower mounting asseulbly.The paao)aose of lhis analysis is to detet'ntine the suitability of the proposed mount will,the Natal loading,atonlapuration;as described in Table 2. This opinion as era accm&=ce'awrith the gtaidehnev aN siaieal in the ANSI TI- 222•IWl Standard A MT 002- M-397(VS)Guidelines nand 10caij eon je reclaaareinaeiats based upon an ulumare'-second 211sa wwirtd speed of 128 taaph without ice.51)mph wwatlt Lo-inch tare iluckness,.and 60 mph undcTMr wTvice Ion&aasilag risk category 11 and exposur category`C aw itch a topo-Draplue i'iactor,kZT,of 1.00.. Based on the attached calculations showing a comparison of the loading.it is our opinion that the proposed ntotunitig assembly is s r ` Ient to support the equipment as shown in Table 2,based on the manufacturer specifications for engineering design. wvwwv.hNIBDG goon 1$00 Route 34.Suite 2209•Will.NJ 07719 732.2805623 Figure 6—Antenna Mount Structural Analysis Report Cover Page Town of Southold—SCTM#1000-108.-4-11.3 AT&T/NYNYNY0228 GRYSCalimW Page 10 C o N S U I, 7 A N T 5 I N C / 9 f Ai M�r li�l // P i r ✓d ffIA �i%�� 0//r/ Ol i ; «; i/ � �1 � i �JI � /f �jG r✓ t r/ll"�) . "2 Radio Frequency Safety Survey Report Prediction (RFSSRP) AT&T Monopole FacilitNt Site Name MATTIT L1CK Site ID. _ .... NYNNNY0228 te Address �415 ELI . —. �......_... . `)>> Si J1HSL<�NE.MAIZIIITCK NY 11 _ Latitude: 40.999472 Prepared for:Centerline on hehall'of Longitude: -72.511 167 AT&T USID: 5679 Fa: 10075046 Report Date:June 12.2024 Centerline PN: Internal . � t eKatrin i Stt�s Reort t Nvlic.h el Fischer Pace ID: �SNP T0044)71 i Report� i�tc o x I ----------- Statement of Compliance AT&T is compliant with FCC regulations. C el]Ielt11K•_?0%V Ceutel Sheet•We,[BmILzewntei•NIA•023,79 t Figure 7—RF Exposure Compliance Report Cover Page FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34520 Date: 0 /25/10 THIS CERTIFIES that the building IN GROUND SWIMMING POOL Location of Property: 745 GAGENS LANDING RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 10 Lot 32 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 24, 2009 pursuant to which Building Permit No. 34642-Z dated APRIL 30, 2009 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 ACCESSORY IN GROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to VINCENT C & DONNA ADALEY of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTHAPPROVAL — N/A ELECTRICAL CERTIFICATE NO. 28816C _ 06/26/91 PLUMBERS CERTIFICATION DATED N/A r Aut obzed gnat/re. Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . . . . . . Date . . . . . . . . . . . . .Deo. . .21. . . . . . .. 19.72. THIS CERTIFIES that the building located at . . . . Gagels LWAIng. R"d- . Street Map No. ]=. . . . . . . . Block No. . . XX. . . . .Lot No.XXX. . . .SOR043.4 . .N oTe . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . - . . . . . . . . . Cat. . 2 . . ., 19. . ,;; pursuant to which Building Permit No. 61 - . dated . . . . . . . . . . . . 40t. . 2 . . ., 19 7?., 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 . Pr vato M.e .f ly, 4 1A - . , . . , . I . . . .. . . . . . . . .. , , . . . . . . . . . The certificate is issued to . . .Jobn fiarabagla . . . . . . .CUMP. . . . . . . . . . . . . . . . . . • . . •. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Dec. 1.9 .1972 . .by H.. 9i1 11. . . . UNDERWRITERS CERTIFICATE No. *. 1$ .1972 .by. J . cki• • • • • . • • • • • • . HOUSE NUMBER. . .? . . . . . .Street. . . ,GaSons IaMing. Road. . . . . . . . . . . . . . . . . . Building Inspector n"111 Suffolk County Dept of Labor,Licensing&Consumer Affairs MASTER ELECTRICAL LICENSE flame ` ANTHONY PARRINELLO Business Name rpvs r..t}.n,14cn}chat m/? nearer is duly licersed PRIVMA ELECTRIC INC :r;J P;e Cau.aruty if sluff all< License Number:PEE-39686 Rosalie Drago Issued: 03122Q006 Con—ssioner Expires: 03(0112024