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HomeMy WebLinkAbout51636-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT 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#: 51636 Date: 02/12/2025 Permission is hereby granted to: Jeffery Strong 1095 Westview Dr Mattituck, NY 11952 To: legalize "as built"central air conditioning,window and door replacements to existing single-family dwelling as applied for. Premises Located at: 1225 Westview Dr, Mattituck, NY 11952 SCTIVI# 139.4-1 Pursuant to application dated 12/18/2024 and approved by the Building Inspector. To expire on 02/12/2027. Contractors: Required Inspections: Fees: As Built Alteration $500.00 CO-RESIDENTIAL $100.00 Total S600.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 rp Telephone (631) 765-1802 Fax (631) 765-9502 https://www.so itholdtowrin . ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only °° w PERMIT NO. Building Inspector;-i D E C 8 2024 Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. �v r Date: aZ OWNER(S)OF PROPERTY: Name: � SCTM#1000- 3 -A),c'✓` 2 (�� Project Address: LyeJ V " ` r Phone#: t Email: c 70'� ' r Mailing Address: ' 1�Y`. � C�c, /,40, CONTACT PERSON: Name: Mailing Address: C '» ! + Phone#: [® r' ` 8 Email ALI) too DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: + Name: w� )k,«i».... g Mailing Address: 0 Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Other + � a— $ 17`a Will the lot be re-graded? ❑Yes�o `excess fill be removed from premises? ❑Yes Flo 1 PROPERTY INFORMATION Existing use of property: j Ar,101'11vt Intended use of property: Zone or use district in which premises is situated: Are there any covenants nd restrictions with respect to ` �f this property? ❑Yes covenants IF YES, PROVIDE A COPY. 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 arne): ❑Authorized Agent 'Owner Signature of Applicant: Date: la STATE OF NEW YORK) COUNTY OF `V. 0e� K' Re- S being duly sworn,deposes and says that (s)he is the applicant kw (Name of individual sig4g contract)above named, (S)he is the (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/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 t day ofJ.)P_,CQnm6e,4- 20 a Notary Public KAREN OLIVER NOTARY PUBLIC-STATE OF NEW PORK PROPERTYT ) . ) No.01 OL6391332 (Where the applicant is not the owner Qualified in Suffolk County Pp � My Commission Expires 05-06-2027 l residing at do hereby rize to apply on my behalf to the Town of Southold Building Depart for ap wal as described herein. 1k Owner's Signature Date Print Owner's e 2 BUILDING DEPARTMENT-Electrical.Inspector TOWN OF SOUTHOLD E dry" 1 7 N ir" Town Hall Annex- 54375 Main Road - PO Box 1179 m+ fir, Southold, New York 11971-0959. ., Telephone (631) 765-1802 - FAX 95Cl2 631 76 - " ( ) . amesh southoldtownn . oar wand southoldton ° oar. APPLICATION FOR ELECTRICAL IN'SRECTION ELECTRICIAN rmation Required) Date: in Company Name. (All info, �.c -r--f c-C—i Electrician's Name: v Q License No.: Elec. email: Elec. Phone No: : ��,�. ...�.� a " $ request an email copy of Ce ifcate of Compliance Elec. Address.: " .NOB SITE INFORMATION (All Information Required) Name: - Address: Cross Street: 1- L„J-Cr Phone No.: vo Bldg.Permit#: email: Tax Mae District: 1000 Section: Block: Lot: 'FORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly), Circle All That Apply: Square Foc�ta e: Is job ready for insptbction?: ® YES 0 NO MRough In Final Do you need a Temp Certificate?: JQ YES[]NO Issued On Temp Information: (All information required) '�,O c Service Size®1 Ph 3 Ph Size: , A # Meters Old Meter# []New Service[]Fire ReconnectFlood Reconnect[]Service Reconnect Underground verhead # Underground Laterals '! n2FJH Frame Pole Work done on Service? Y N' Additional Information: PAYMENT DUE WITH APPLICATION, 0,50o DATE(MMIDD/YYYY) lliN.� " CERTIFICATE OF LIABILITY INSURANCE 04/03/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(lies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Molly Rice PRODUCER NAME: IPHON 800 748-0224 FA_X Global Marine Insurance Agency Arc o ( ) Alc„No a 12935 S West Bayshore Dr AE-DDRESSt MAIL mrice@globalmarineinsurance.com Ste 205 INSURETII'S iAFFORDNNG COVERAGE NAIC p Traverse City MI 49684 INSURER Hanover Ins Co '..INSURED INSURERB: Navigators Insurance Company,The Strong's Marine,LLC etal INSURER C: PO BOX 1409 INSURER D: INSURER E: Mattituck NY 11952 INSURER F; COVERAGES CERTIFICATE NUMBER. CL244314394 REVISION NUMBER: THI 11 S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN„THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY Exp rRA TYPE OF INSURANCE # POLICY NUMBER MAN Epp LIMITS XCOMMERCIAL GENERALLWBIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ©OCCUR PREWI E;SEa w;cu—noo) $ 100,000 )< Marine Op Legal Liability MED EXP(Any one person) $ 10,000 X P&I Liability IHWA60071009 03/31/2024 03/31/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2.000,000 PRODUCTS $ 2,000,000 POLICY fJ'�' El LOC - OTHER: Marine Op Legal Liability $ 1,000,006 AUTOMOBILE LIABILITY [BODILY ident quELiMI1' $ 1,000,000 ANY AUTO INJURY(Per person) $ A ..OWNED SCHEDULED AVVWA59151109 03/31/2024 03/31/2025 INJURY(Peraceident) $ AUTOS ONLY AUTOS HIRED NON-0WNED RTY DAMAG".,E $ AUTOS ONLY AUTOS ONLY cident Hired/Non Owned Liab $ 1,000,000 X UMBRELLA LIAB '...00CUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB cNAIMs-MADE IHWA60077609 03/31/2024 03/31/2025 AGGREGATE $ 5,000,000 DED IRETENTION$... 0 $ WORKERS COMPENSATION PER OTH STAT TE ER AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE r�..�ry E.l..EACH ACCIDENT $ A OFFICERIMEMBER EXCLUDED? LJ NIA VV2VVD48634806 03/31/2024 03/3112025 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISE.ASE-POUCYLIMIT $ 1,000,000 $4,000,000 Second Layer-Excess Liability g 24L843802 03/31/2024 03/31/2025 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate Holder is included as additional insured with respect to the above captioned general liability per terms/conditions of actual policy&by written contract. CERTIFICATE HOLDER CANCELLATIONI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 9W� T � - - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date P&I Liability-Marina Operations Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref# Description Coverage Code Form No. Edition Date P&I Liability-CREW Limit 1 Limit 2 Limit 3 Deductible AmountT eductible Type Premium 2 Ref# Description Coverage Code Form No. Edition Date GL Broadening Endorsement Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Included Ref# Description Coverage Code Form No. Edition Date Sudden&Accidental Pollution Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref# Description Coverage Code Form No. Edition Date WSL for Demos Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Included Ref# Description Coverage Code Form No. Edition Date 2006 PumpOut Wk Boat Limit 1 Limit, Limit 3 Deductible Amount Deductible Type Premium Liab ONLY Ref# Description Coverage Code Form No. Edition Date Personal Use-Key Personnel Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Included Ref# Description Coverage Code Form No. Edition Date Special Al Endt 09.05.19 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date P&I Liability-Watersports Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Included Ref# Description de Form No. Edition Date P&I Liability-Rental Boats Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref# Description Coverage Code Form No. Edition Date PIP-Basic PIP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 50,000 OFADTLCV Copyright 2001,AMS Services,Inc. ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Uninsured motorist combined single limit UMCSL Limit 3 Deductible Amount Deductible Type Premium Limit 1 Limit 2 1,000,000 Ref# Description Coverage Code Form No. Edition Date Auto Broadening Endt-included Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Medical payments MEDPM Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 10,000 Ref# Description Coverage Code Form No. Edition Date Rental Boat Operations Limited Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 3,000,000 Ref# Description Coverage Code Form No. Edition Date Experience Mod Factor 1 EXP01 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 ffmlt3 Deductible Amoun�tDeductible Type ' Premium ff[!cription� Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 T�� Limit 3 Deductible Amount Deductible Type Premium Limit I Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001,AMS Services,Inc. AGENCY CUSTOMER ID: 00001098 LOC#: AC"RV ADDITIONAL REMARKS SCHEDULE Page of '..AGENCY NAMED INSURED !Global Marine Insurance Agency Strong's Marine,LLC eta[ POLICY NUMBER CARRIER fL EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes Location#Address 1 City State Zip 00001 2400/2402 Camp Mineola Rd.Mattituck NY 11952 00002 781 North County Rd.39 Southampton NY 11968 00003 1810 North Sea Rd.Southampton NY 11968 00004 15 Orchard Beach Blvd Port Washington NY 11050 00005 2255 Wickham Avenue Mattituck NY 11952 00006 1780 and 1784 North Sea Rd.Southampton NY 11968 00007 Corner of Rt.48&Wickham Ave Mattituck NY 11952 00008 1 Orchard Beach Blvd Port Washington NY 11050 00009 86 Orchard Beach Blvd Port Washington NY 11050 00010 405 Main St.Port Washington NY 11050 00011 5780 West Mill Rd.Mattituck NY 11952 00012 435 S.Main St.Freeport NY 11520 00013 500 S.Main St.Freeport NY 11520 00014 423 Three Mile Harbor HC Rd/Harbor Marina East Hampton NY 11937 00016 6 Boat Yard Rd/Three Mile Harbor Marina East Hampton NY 11937 00017 10 Shore Walk Bay Shore NY 11706 00018 74 Little Neck Rd Southampton NY 11968 00019 2655 Wickham Ave Mattituck NY 11952 00020 2739 Wickham Ave Mattituck NY 11952 00021 9605 Main Road(Lot 12)Mattituck NY 11952 00022 9525 Main Road(Lot 13)Mattituck NY 11952 00023 9475 Main Road(Lot 14)Mattituck NY 11952 00024 9487 Main Road(Lot 15)Mattituck NY 11952 00025 9489 Main Road(Lot 16)—Vacant Land GL Mattituck NY 11952 00026 8000 Skunk Lane Cutchogue NY 11935 ACORD 101 (2008101) © 2008ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds jr��ateway of Flande.i,.'Isp Enc Addi.L.J.-onal Named insured Jeffrey Strong Addi.tional. Named Insured Re Strong Add.i.ti.onal. Named Insured Strong's F G.r.overs at Atlant.ique, LI,C [.J.mited Liability Company, Additional Named Insu.1-ed Strong's Old Fort Pond Marine, LLC. L-A.xyd.Led 1..,i.ability Company, AdditionzAl Named lnsur(-,�d Strong's #9605 Main Road, L:LC Li.m.i.ted LJ..abi Li ty Company, Additional Narvied :11'lsu:r(..,.d S Lt.ong s Broadwat.ers Cove Marina, LLC Limi.ted Liability Company, Additional Named Insured S tron g a Marime, Boat Rental, Inc. Additional. Natned Inst.ired S t.rong s Marine lnleL, F..,F..,C Limi-ted L.J.-abil.i.ty Company, Additiona.l. Named In::.;ured Strong's Mar..J..ne of East Hampton Additional. Named Insured Strong's Ma.rine of F..Landers,, LLC Add.it.i.onal Named Insured Strong's Marine of Southampton Management, L:LC Addi,ti o n a 1. Nained Insured S t r on g a Ma.r.i.ne of Southampton Marinao LI.,C Addj.tional. Named Insured t rn-ng s Marine of Southampton Showroom, LLC Additional Named Insured St.:rong a Mar.i.ne, Inc Addi-tJ..o n al. Named Insured Strong a Water C.Lub & Mar.i.na, I1C Add.i.tional Named Insured Strong's West 1111I.A., LLC L.J.-mited Liability Company, Add.i.tional Named Insured Strong's Yacht (..enter, LLC L.J.-mited Liability Company, Additional. Named Insured OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC QRK workers' CERTIFICATE OF INSURANCE COVERAGE �r, Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Strong's Marine LLC. 631-298-4770 2400 Camp Mineola RD Mattituck NY 11952 1 c.Federal Employer Identification Number of Insured Work Location of Insured(On►y requ►red if coverage Is specHlcalry limited to certain locations In New York State,i.e.,wrap-lip Po►lcy) or Social Security Number 11-3632850 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New York State Parks, Recreation&Historic Preservation Standard Security Life Insurance Company of New York 3b.Policy Number of Entity Listed in Box"l a" L22138-000 625 Broadway ALBANY, NY 12238 3c.Policy effective period 1/1/2019 to 12/12/2025 4. Policy provides the following benefits: x❑ A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: XD A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employers employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insure coverage as described hove. Date Signed 12/13/2024 By (Signature v nsurance carrier's auto ed a Insurance Agent of that insurance carrier) Telephone Number (212)355-4141 Name and Title Bebi Ishmail,Supervisior-DBUPolicy Services IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 413,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law.It must be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(Only if Box 4C or 5B of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied With the NYS Disability and Paid Family Leave Benefits Law With respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to Issue this form. DB-120.1 (10-17) IIIIIIIIIIIIIIIIIIIIIillillillilIIlilljI Additional Instructions for Form 1313-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in box"1 a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices my be sent by regular mail.)Otherwise„this Certificate Is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c,whichever is earlier This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or paid family leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (10-17)Reverse S.O.T.M. N0. DISTRICT:1000 SECTION:139 BLOCK:7 LOT(S):1 lN78'42'40"E 170.17" V O �e ASPHALT ORNEWAY v1 ZONE AE(EL 8) �o �] ZONE X T 1 A nt r /r223 U.P. V � Tr r; I o o w DRY N£LL 4-9- 2t8.B8' 50.O BROWER ROAD FEMA MAP 36103C0481H I THE WATER SUPPLY, S, WELLS AND CESSPOOL LOCATIONS SHORN ARE FROM FIELD OBSERVA71ONS EFFECTIVE 09/25/2009 AND OR DATA OBTAINED FROM OTHERS g AREA.34-390 SOFT. OR a79 ACRES ELEVADAN DAfuu: iF UNAUTHORIZD ALTERA170M OR ADMI70N TO POS SURVEY IS A VIOLATION OF SECTION 7209 OF TW NEW YORK STATE EDUCAUON LAW. COMES OF RQS SURY£T MAP NOT BEARWG THE LAND SURVEYORS EMBOSSED STEAL SHALL NOT BE COVSOERED TO BE A VAUD TRUE COPY. GUARANTEES INOYC47ED HEREON SHALL RUN ONLY TO WE PERSON FOR IWOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO WE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSRR/RON LISTED HEREON,AND TO DIE ASSCHEES OF WE LENDING INSWUROV,GUARANTEES ARE NOT TRANSFERABLE TS WE OFFSE OR DIMENSIONS SHORN HEREON FROM THE PROPERTY LWES TO THE SMU07URES ARE FOR A SPECIIRC PURPOSE AND USE THEREFORE THEY ARE NOT WTENDED 70 MONUMENT THE PROPERTY LINES OR 70 GUIDE THE ERECRON OF FENCES ADDI7IOYAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT OVARANhFO UNLESS PHYSCAU.Y ENDENT ON 711E PREMISES AT THE TIME OF SURVEY wrtvEY OF.. DESCRIBED PROPERTY ' CERTIFIED TO: JOSEPH MOISA; MAP OR FILED: — \ \ SITUATED AT.MATTITUCKlE TowN OF.SOUTHOLD SUFFOLK COUNTY, NEW YORK KENNETH Y 40YCHUK LAND SURVSYLNG,PLLC Professional 1 nd Surveying and Design P.O.Box 153 Aquabogue,Now York L1931 13-227 PHO=Id+Ilrx-lees ra(63)M-Tees FILE/ SCALE;1"=30' DATE FEB. 16, 2014 t 8 OM