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HomeMy WebLinkAbout51748-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#: 51748 Date: 03/17/2025 Permission is hereby granted to: Mark D Zablotny 1385 Jasmine Ln Southold, NY 11971 To: construct accessory in-ground swimming pool as applied for. Premises Located at: 1385 Jasmine Ln, Southold, NY 11971 SCTM# 69.-3-24.7 Pursuant to application dated 02/10/2025 and approved by the Building Inspector. To expire on 03/17/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total S400.00 BuildingInspector�._�.....�_. ctor TOWN OF S®UTII®LD—DITILDING DEPARTMENT Town Hall Annex 54375 Main Load F. G. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 lit .f www. outlaoldtownrt 0V Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only G Building Inspector: , PERMIT N0. ts� , + O AppIications qn d forms mqust be filled out jn their entirety.Inca n.- applications will rnot be accepted: Wheri�#the Appgcant is no#the owner,an Owner's Authorization form(Page,2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: SCTM#1000- W-3- 2�,r7 Project Address: t3�J �Q5mirir� L-0 �QU ,o)'0 Ivr l j q7l Phone#: �31- ao - - Vf09 Email: Mailing Address: CONTACT PERSON: Name: Mailing Address: Phone M Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Narne: w�coS Mailing Address: (1 Z�ij R� ��A i i 1� p��ce 117 V Phone#: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑ ❑ Estimated Cost of Project: Addition ❑Alteration Repair ❑Demolition Estimated C5iOther (i it L... 1rV t Will the lot be re-graded? RlYes ❑No Pao L*eA On Will excess fill be removed from premises? Ayes ❑No 1 PROPERTY INFORMATION i Existing use of property: nn � Intended use of property: � P ww &>( cry fj i 1 G �.sC� Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes �410 IF YES, PROVIDE A COPY. ec k Oi e d(ng� got o r/contrador/%hes n protessionii,I's+ ,SP! rfW0,faar A0*41"Ass irufoorihwater IsioesAs or6Witl by chd ptjr of the Torn Code,, APPLICAT1,6N jSrj*4f6Y MADE to the Building,Otpartment for the,Issuance of a Bullding permit puttuaht to the sultdIft zone 044atCO of the ro+atn of oaatfunaVd, aaffofg„Cdpr�t Ne~aar York enai lather apolicAte ice,Ordinances or Regulations,for the construction off Tidings, a�gti lkw tiorm or rn for r orra�l or dea�ftinn4s herein describe ,The pig at ogre"to comply with ph ppp� a bwwaae,owdi a�d , wide is e, houslagcode and togulatimcs and to admit earthorixed Inspectors on prarritsis and IntrulIdfnp,O for"° rp Inspections.Fg1st statements,made herein are punishable as as ass A mitdemeanot pursuant to sectbon110:45 of the IhPeW YOria stafd penawt U w. Application Submitted By(print name): :1A7b� ❑Authorized Agent g3owner Signature of Applicant: !'p Date: b ^Z� STATE OF NEW YORK) SS: COUNTY OF APE r 1 lak being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) a, ove named, (S)he is the 0Hvee (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 day of /t 1 �,2026' 4No ary Public MARGARE F A. KIDNEY Notary Public—State of New York Qualified in Suffolk County PROPERTY OWNER AIJ.� ...,. �• � •••• My Commission Expires March 8,2027 (Where the applicant is not the owner) I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 NYSIF PO Box 66699,Albany,NY 12206 Now York State Insurance Fund nysiEcom CERTIFICATE OF WORKERS' COMPENSATION "" INSURANCE .. 0 n n n n n n 112377925 � LEVITT-FUIRST ASSOCIATES LTD 520 WHITE PLAINS ROAD,2ND FIL TARRYTOWN NY 10591 ifffimin ;r SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARTHUR J.EDWARDS POOL&SPA CENTRE TOWN OF SOUTHOLD ARTHUR J.EDWARDS TOWN HALL 929 RTE 25A P.O.BO 1179 MILLER PLACE NY 11764 SOUTHOLD NY 11971-0959 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 2438 491-9 881298 06/29/2024 TO 06/29/2025 06/26/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2438 491-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/ CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND //" 4 DIRECTOR,I SURANCE FUND UNDERWRITING VALIDATION NUMBER: 633467799 11oNlNllw "0 11111 Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-24384919] U-26.3 7 [00000000000129018175][0001-M243849191[X NG][16418-05][Ceil NoP-CERT 1][01-M1] 0 F CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY1) 12/1212024 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(les)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 endorsements. PRODUCER CONTANA , Rebecca An ellnas NAME - Liberty Risk Management, Inc. PHONE 3�063169 6 N) 631569 5636 2333 Route 112DR rb,caIibrtisk ark Medford, NY 11763 INSURERS AFFORDING COVERAGE ....w„m w .... ,,,mmk wNAIC# ., . .... �.w.ww........ _ _.w._._. _ 1NSURERa:........�Iel�Iwiphsurance..C.ompanJl__... ...w_...M ....... INSURED:...._.................................. www..._.w.. INSURER B Arthur J. Edwards Mason Contracting Company Inc. INsuRERc: - w -w----ww_---- Www w _. .,_----- _ „`. DBA:Arthur J. Edwards Pool &Spa Centre _... 929 Route 25A JNsURFR 2..:...... ........:.:.:.:.:._........._.mmmm.w_.w.w.._.._..w............... .._mw..._.w.ww � .w......._... Miller Place, NY 11764 INSURER F................... _, ...wwwww_........_.m INSURER F: COVERAGES CERTIFICATE NUMBER: 00000005-0 REVISION NUMBER: 63 THIS 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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. _ LTR ...ww....................................................... .�.w:.______,,, ., 6v wwwww_.......................-,....------- .�........ _P'-Oudy.E`�._. [�iKldv F" ..... LIMITS TYPE OF INSURANCE POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY Y NPC-1004300-04 1/1/2025 1/1/2026 EACH OCCURRENCE $ 1 OOO OOO FRI,._.- CLAIMS-MADE OCCUR v(?:.RM,I:..Er,`LI;. 'PI/.GT.�S!.Ra..,:.-- .$-w-w__.._._.,. OOO.UO..M MED E XCP(An one person) $ 5 OOO PERSONAL,&ADV INJURY $w w 1000000 GEN'L AGtaREGP41"E LIMIT APPLIES PER: GEN_E_RAL AGGREGATE_ $ 2 000000 POL,IC^,I�_, JECTPRO- LOC PRODUCTS COMP/OP AGG $µ w www?OOO,OOO OTHER: _._._ ........_............ $ AUTOMOBILE LIABILITY M I fC LE LIMP $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED .-,.wwww....w_...�...w.............__ .www-w-_- AUTOS ONLY ,, AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Par acb¢rttww. ,,,, $_._.......__m_mw-w-w-...._ m.. UMBRELLA LIAB '...OCCUR _EACH OCCURRENCE_ $ _.. EXCESS LIAB CLAIMS-MADE AGGREGATEmm $ ............. DED — RETENTION$ _._ww...ww....ww__.. $ WORKERS COMPENSATION FY- AND EMPLOYERS'LIABILITY Y/N ........ ...:w...................:.:._...._..._m-www-.-w.,,. ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E..L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.LwDISE4SE-E A EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Town of Southold is included as an Additional Insured,ATIMA,as requiried by written contract and subject to policy terms, conditions,and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 728 Southold, NY 11971 AUTHOR REPRESENTATIVE 11 RPA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by RPA on 12/12/2024 at 08:15AM k Workers'Compensation CERTIFICATE OF INSURANCE COVERAGE A11r Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured ARTHUR J EDWARDS MASON CONTRACTING COMPANY INC DB ROUTE UR J.EDWARDS POOL AND SPA CENTER929 6317440174 MILLER PLACE,NY 11764 Work Location of Insured(Only required if coverage is specffically limited to 1c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier TOW N Be LSOUTHOLed as the ID to Holder) Standard Security Life Insurance Company of New York PO BOX 728 3b.Policy Number of Entity Listed in Box I SOUTHOLD, NY 11971 Z06874-000 3c.Policy Effective Period 7/1/2020 to 6/4/2025 4. Policy provides the following benefits: 0 A.Both disability and Paid Family Leave benefits. ❑ B.Disability benefits only. ❑ C.Paid Family Leave benefits only. 5. Policy covers: ❑X A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's 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 insurance coverage as de d above. A. Date Signed 6/5/2024 By (Signature of insurance carrier's authod d rep resent at r NYS licensed insurance agent of that insurance carrier) Telephone Number 212 355-4141 Name and Title SUPERVISOR-DBL/POLICY 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 emailed to PAU@wcb.ny.gov or it can 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 48,4C or 56 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(Article 9 of the Workers'Compensation Law)with respect to all of their 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 (12-21) I Il � iiii�iiiiiiii � aid -7 % & A" i-N 0- gawk, --NION-§Ppt 4'i MX"AN T IN -VEEN, UNA ........ ..... 5, S uffo vir Ik County Department of Lavor, Licensin & fl U -1- lei onsumer Affairs kk VETERANS MEMORIAL HIGHWAY HAUPPAUGE, NEW YORK 11788 'A A-11 'R A Z�! �F .............. DATE ISSUED: 07/01/1978 No. H-4436 a X COT,-.-NTY '0 St,FF0T Home Improve ment ntractorLicense 'I This is to certify that ARTHUR J EDWARDS I At T doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DBA (I SUPP) XY J" gc having furnished the requirements set forth in accordance with and subject to the provisions of applicable 1 laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct I V business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. NOT VALID WITHOUT Restrictions Additional Businesses DEPARTMENTAL SEAL AND A CURRENT H1-GC; ARTHUR J EDWARDS POOL&SPA CENTRE 5 H26-Pools and Spas/Certified; `01 CONSUMER AFFAIRS 4i H3 Pools/Spas fl Suffolk County Dept.of ID CARD Labor,Licensing&Consumer Affairs 31 HOME IMPROVEMENT LICENSE Name A ARTHUR J EDWARDS Business Name ARTHUR J EDWARDS MASON This certifies that the CONTRACTING CO INC DBA(1 SUPP) Rosalie Drago bearer is duly licensed by the County of suffolk License Number H-4436 Commissioner Issbed;, 07/01/1978 ig'z Expires: 07/01/2026 Commissioner ,a WMM M =4- "-' �" - ik"'�g', - - 11'MR, F-MIK-1010W R MIN, W t APP O EO AS NOTEO 1A B.P.# fit n� FEE BY: NOTIFY BUILDING DEPARTMENT AT RETAIN STORM WATER RUNOFF 631-7fir1802 8AM TO 4PM FOR THE �: PURSUANT TO CHAPTER 236 FOLLOWING INSPECTIONS: 1. FOUNDATION-TWO REQUIRED OF THE TOWN CODE. FOR POURED CONCRETE 2. ROUGH-FRAMING&PLUMBING 3. INSULATION 4. FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTON ERRORS COMPLY WITH ALL CODES OF INSPEC71ON REQUIRED NEW K STATE&TOWN OODES AS REQUIREDNSOF AND N �� ic . NC" SI POOL C E - S SCr CHD omPLEVON OCCUPANCY OR USE IS UNLAWFUL WITHOUT r I T New York State Law YOU Must Call 811 OF OCCUPANCY Before You Dig A a �.. F1Er Flom !PunP To T.rbbn ONY M OPUNO Reid Nh� Plan - Piping . Arrangement 42" 3 Section B—B r P=C. z y Section A—A Typical Wall Section SIZE I A B C I D E F G H AREA CAP can FEET FT FT FT I FT FT FT FT FT SQ.FT GAL. f Ylapk ZAb l 14 X 30 14 30 10110 7 3 3 8 420 12,OW 13K JC S m i e- L n Pool$SPA CWM 16 X 34 16 34 10114 6 1 4 1 4 18 544 21,000 PERMACRETE WALL SYSTEM 0 �l 18 X 38 18 38 14114 6 41 51 8 6134 24,0001929 Route 25A Miller Place NY 11764 /�, 20 X 40 20 40 16114 6 4 5 10 800 33,000 (631) 744-7185 FAX (631) 744-0174 �') ��- � Q% 24 X 44 24 44 18 14 8 4 8 10 798 35,000 Suffolk License #4436—M Nassau License #HI74450000 24 X 49 24 48 20 16 8 4 6 10 900 38,500 The locations of wells and cesspools SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES \ shown hereon are from field observations FOR APPROVAL OF CONSTRUCTION ONLY 27. and or from data obtained from others. DATE S.REF.NO. 93 SO 25 W R-50-00 £ jL=01.98 S 't�yS ��- APPROVED f 'g�sT sT f �10 Sao 1m ,t r SURVEY OF 1 LOT 7 u - 5a xrAP oFsourttocn vain sEcrroN rwo« r FXED AW% 4,W3 FaENQ A-434 A T SOUTHOLD TOWN OF SOUTHOLD lie R' SUF FOOLKCOUNTY N. Y. nor ,a s Scab. 1"= 40` Q 1 A, v Mar. 15, 1993 T Oct.21, 1993(foundation) I l07- E Q MayJULY 11, 1994(Final)IONS ADDED) o � CERTIFY TO: 2g. O �eni� *pt MARK D.ZABLOTN,')�o ' s Hose �� AREA =23,475 sq !t t. FIDELITY NATIO�rj;�-F §I fi'NCE COMPANY C�,, FLAGSTAR BA 4gJ�'IV sos t !�{ The water supply and sewage disposal©we PFY 9 F t1 Y.S. LIC, NO. 49618 Nl1 t systems for this residence will conform g Prepared in accordance with the minimum tJlljlj standards for title surveys as established to the standards of The Suffolk County PEcQNt . b& P.C. (��+ y Deportment of Health Services. ELEVATIONS ARE REFERENCED Qn1}t� by the L.I.A.L.S.by he appro or and adopted P.O.B76a.0?� 1}765-1747 To AN ASStA4Eo DATUM. for such use by The New York State Land P.O.BOX 904 Title Association. 1230 TRAVELER STREET SOUTHOLD.NY 11971 n.4 1=C The locations of wells and cesspools SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES �\ shown hereon are from field observations FOR APPROVAL OF CONSTRUCTION ONLY and or from data obtained from others. 37o DATE NS.REF.N0. s3 so 25 h- R-5C CC. ? APPROVED tt .40 f ago iJ Nff�( tly jj As, ,I39 o a SURVEY OF ,3 LOT 7 'MAP OF SOLtMt1OLD VX"A SECTION TWO" ryf f FEED AW% 4j=FXE NO.A-434 j A T. SOUTHOLD od TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000- 69-03-24.7 O T a Q Scale: 1"= 40` Mar. 15, 1993 T Oct 21,1993(foundation) Q May 11, 1994(F'ino + 1Or U5 JULY 22,2014(CERTIFICATIONS ADDED) -x\ CERTIFY TO: MARK D.ZABLOTN AREA =23,475 sq. ft. FIDELITYNATIO`rFfl .T€ 5 \TECOMPANY N T5= d er,f �, FLAG STAR BANK Alllowc- 60.00, I Fl 0( The water supply and sewage disposal J N Y.S. LIC. N0. 49618 HI1 systems for this residence will conform id L Prepared in accordance with the minimum to 'the standards of The Suffolk County PEb£N' -SL-V—E ,P.C. �11t� standards for title surveys as established Department of Health Services. ELEVATIONS ARE REFERENCED COy?p by the L.LA.L.S. and approved and adapted P(631} (t--3' F�{(,1)765-1797 TO AN ASSUMED AR DATUM. for such use by The New York State Land P.O.BOX 909 Title Association. 1230 TRAVELER STREET SOUTHOLD,NY 11971 nw •cc The locations of wells and cesspools SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES shown hereon are from field observations FOR APPROVAL OF CONSTRUCTION ONLY and or from data obtained from others. 37 a DATE HS.REF,N0. 93 SO 25 h- R-50.00' L=21.9� $ 3js APPROVED ! t N .40 3Ra P' �A `?Q SURVEY OF ° Q LOT 7 = s3. 'MAP OF SOUTHOLD ViiLAS,SECTION TWO" FXED AM 4,M3 FXENO.A-434 A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000- 69-03-24.7 Lor ray Q Scale: 1"= 40` 1 Mar. 15, 1993 l Oct 21, 1993(foundation) l j lOr May� JULY 2,12014(CERTIFICATIONS ADDED) C6 CERTIFY TO: MARK D.ZABLOT-N- EQse y\ AREA =23,475 sq ft FIDELITY NATI%Ijkj -_fiT RS I � ECOMPANY A S^ rne7t FLAGSTARBA `^g Tf�g 3¢5 6000, F1Q{�i�c . The water supply and sewage disposal N:Y.S. LtC. NO. 49618 systems for this residence will conform ! Z Prepared in accordance with the minimum ' lIl(� standards for title surveys as established to the standards of The Suffolk County PECQhIt P.C. �COR,o by the L.GA.L.S. and approved and adapted Department at Health Services. P(6311-'7i;i t ��te,l)765-1797 ELEVA WNS ARE REFERENCED for such use by The New York State Land P.O.BOX 909 TO AN ASSUMED DATUM. Title Association. 1230 TRAVELER STREET SOUTHOLD,NY 11971 n.w -Wr