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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31909 Date: 10/16/06
THIS CERTIFIES that the building ADDITION
Location of Property: 18275 MAIN RD MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 115 Block 2 Lot 11
Subdivision Filed Map No. Lot NO.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 3, 1995 pursuant to which
Building Permit No. 22893-Z dated JULY 17, 1995
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 TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to HENRY RUTKOSKI & WF
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. H 046602 08/16/95
PLUMBERS CERTIFICATION DATED 08/11/95 HENRY RUTKOSKI
"-4 ~ - 1,"4w
tho zed gnature
Rev. 1/81
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWM HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED) G~
NP 22893 Z Date ....711.7
Permission Is hereby grant to:
X:1
. S?-....................9 Z
to .........Q
at premises located at..... w.......................................................
...%%ry...•••'••' //~S-................
County Tax Map No. 1000 Section........ 11.5....... Block .....Q..... Lot No.
pursuant to application dated 4- .;6 19...Y.. , and approved by the
Building Inspector..
Fee 7?....fj
L--''gym} .1.......
/ Iding Inspector
Rev. 6/30/80
` • Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL 6
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANc-,%E------- ^
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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 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.
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, Commercial $15.00
v Date. Lif /Q(/ ~Q
New Construction: Old or Pre-existing Building: (check one))
Location of Property: J ,7 7 S_ n ^ I ICJ fZ~ i t AT T l T U C. K-
House No. Street Hamlet
Owner or Owners of Property: N it y J f K o S -h Wi~',
Suffolk County Tax Map No 1000, Section S" Block ~ Lot
Subdivision Filed Map. Lot:
Permit No. e' 3 y, Date of Permit. ~QS` Applicant: e W QY /~J R y7l~USkc, K °V f .
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ no
.3 t g o q 1 -
t?'1 Applicant Signature
- - - - - - - - - - - - - - - - - - - -
THE NEW YORK BOARD OF FIRE UNDERWRITERS P1= 1
8055630 BUREAU OF ELECTRICITY
F 85 JOHN STREET. NEW YORK, NEW YORK 10038
Date AUGUST 16,1995 Application No. on file 88946495/95 H 046602
THIS CERTIFIES THAT - -
only the electrical equipment as dsacribed below and Introduced by the applicant named" the above application number in thepremises of
HENRY-HELEN RUTKOSKI, 18275 HAIN ROAD, MATTITUCK, N.Y.
in thefollominR location; ? Basement A Ist Fl. D 2nd Fl. OUT Section Block Lot
was examined on AUGUST 07 ,1995: and found to be in eomrplibact, with the Aaaamst Mectrie Cade.'
FIXTURE R%TURES RANDS COOKRIO DECKS OVENS W UST FANS
OUiIETS ECBTACLB SWITCHES INCANDlSCEM r14 UORESCENT OTHER NAT. K. W. AMT. K. W. AMT. K.W. MT..... X. W. AMT. X. F.
2 6 3 FURNACE MOTORS PUTURE ANUANCS IE MO SMALMCPT TIM1CtOCIIS&W REATIRS AI WMMERS
!71 aL H. P. GAS X. P. AMT. NO. A. W.G. Mr. Me. AMT. AMrE. TRANS. AMT. n P.. ~T NAT. WATTS 1 1 lfi III 1=
SERVICE DISCONNECT NO. OF S E It V 1 C C~Mfr. AMP. TM P. j1 A tW 1 / 3W 3 / 3W 3 N -c*pA `COND. OF e &ONO. NO. OF HIAto OF W_ NO.OF WWRAM OF MLG. L '
OTHNT APPARATUS:
FOUND BLDG. IN COMPILIANCE AS PER-1
REQUEST-1
HENRY-HELEN RUTKOSKI
18275 MAIN ROAD
MATT ITUCK, NY, 11952 tiE~i111liL~AANAaN1
li
Per
This certificate must not be. altered in any manner; return to the office. of the Board if incorrect. Inspectors.. may, be Idellt'died by Nleir credentials.
4.
COPY FOR BUILDING DEPAR MENTTMCOPYOF=nRCMMUBTDI r=ALmmsoAWnson
I µ
J `
Town Hall, 53095 Main Roadi Fax (516) 765-1823
P. O. Box 1179 j r Telephone (516) 765-1802
Southold, New York 11971
,S
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE:
Building Permit No. pz9-,Y93 C-
Owner: A& W P--y R
( lprint)
Plumber: P A/y -~4 R-1-Fk US
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(Plumbers Signature)
Sworn to before me this
y day ooff i 19
Notary Public, Ya ~i Coun~y
HELENE D. HORNE
Notary Public, State of New York
No.4951364
Qualified in Suffolk County
Commission Expires May 22, 19 2z
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ;IN TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS :
DATE INSPECTOR
I
M-1802
BUILDING DEPT.
INSPECTION
[ FO DATION 1ST [ ] ROUGH PLBG.
[ FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: 91-'"
T
DATE INSPECTOR NUJ
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE 71,A INSPECTOR
765-1802
BUILDING DEPT.
INSPECTIO
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
zg:o 3'r'
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO H PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
DATE INSPECTOR
J
765-1802
BUILDING DEPT.
SPECTION
FOUNDATION 1 ST [ ] ROUGH PLBG.
I [ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE 0 J l INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS _ N
R1
II II ~
H ~
FOUNDATION (1ST) II II a
II l
III
II ii I c
it
y
FOUNDATION (2ND)
=ss-------------
II II /yyrT~ `1
0
ROUGH FRAME 6 II
~ U
II
PLUMBING ii It
_ ~ ,,L (wvll`
I~ IN ~ ~ ECG
I~II
II It
L7y~
II It
y
II
INSULATION PER N. Y.
H
u
STATE ENERGY
CODE
II it
~ II I
a II O ~ CE
I
II It n n
II
I~I
FINAL - I-il
Ifi II
ADDITIONAL COMMENTS:
i a
I
H
n
v
c
,H
APPEALS BOARD MEMBERS o~0$11FF~~,~-C
GGy Southold Town Hall
Gerard P. Goehringer, Chairman c 53095 Main Road
Serge Doyen, Jr. W x " P.O. Box 1179
James Dinizio, Jr. O Southold, New York 11971
Robert A. Villa y?jCl ~a0~ Fax (516) 765-1823
Lydia A. Tortora Telephone (516) 765-1809
BOARD OF APPEALS
TOWN OF SOUTHOLD
DATE OF ACTION: July 12, 1995 APPL. #4318.
APPLICANT: HENRY RUTKOSKI.
LOCATION OF PROPERTY: 18275 Main Road, Mattituck, NY
COUNTY TAX MAP DISTRICT 1000, SECTION 115, BLOCK 2, LOT 11.
BASIS OF APPEAL: Notice of Disapproval issued by the Building Inspector
dated May 31, 1995: "Proposed construction will have insufficient rear yard
setback... proposed addition to dwelling would cause existing accessory
to be in a side yard and accessory buildings shall be located in a rear yard."
Zone: R-40 Residential.
PROVISIONS APPEALED FROM: Article IIIA, Section 100-30A.3, A.4.
RELIEF REQUESTED: 10' x 12' addition (mud room) extending at the
northerly corner of the existing dwelling into the present rear yard which
normally would not require a variance except that the addition will now place
existing accessory garage in what is considered a "side yard" area.
Accessory garage are not permitted in side yard areas without Board of
Appeals approval. Setbacks of accessory building will not be changed by this
application. and proposed addition will comply with all setback and other
zoning restrictions.
MOTION MADE BY: Gerard P. Goehringer, Chairman
SECONDED BY: James Dinizio, Member
ACTION/ RESOLUTION ADOPTED: Granted permission to maintain existing
location of accessory garage as built and due to the proposed construction of
a 10' x 12' addition is placed in a side yard area. (Note: No conditions
of variance except as provided by all other codes of the Town of Southold.)
REASONS /FINDINGS: Addition will meet all zoning restrictions. Garage
existed for many years in its present location. Relief requested is minimal.
Under the circumstances, project is not unreasonable and will not cause a
detriment to nearby properties or adverse impact on the physicial or
environmental conditions in the neighborhood or district; although the
difficulty may be considered by a court of law as self-created, the board does
not feel it should preclude the granting of this area variance.
VOTE OF THE BOARD: Ayes: Serge J. Doyen, Member
Robert A. Villa, Member
Lydia A. Tortora, Member
James Dinizio, Member
Gerard P. Goehringer, Chain j
This resolution was unanimously adopted.
v
GERARD P. GOEHRINGER, CHAIRMAN
FORM N0.3 'K
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
Date 101V 199-5-.
Tol~elzzr frT.S'...
a
PLEASE TAKE NOTICE that your application dated • • , . • • , , . 1
for permit to C4y4 . G?C?18~? . ~p~ l at
Location of Property
5...`~ /a? GC~/
House se No. No. " " " '
Street Hamlet
County Tax Map No. 1000 Section Block Lot ,lam
Subdivision Filed Map No. Lot No.
is returned herewith and disapproved on the following grounds . Ui
.loo.--30. F.r~.~.... ~0.0.-3.3~.... ....4~~~~a... .
w~~
.rte... ! 9~ . .z?~~. .
• •j'^ • • . . . r .
. .
ui ng Ins"Y(ector
RV 1/80
BOARD OF HEALTH
? FORM NO. 1 i-3 SETS OF PLANS .
TOWN OF SOUTHOLD 1_ SURVEY . . . .
MAY - 31995 BUILDING DEPARTMENT ,~CIICCK . . . .
TOWN HALL SEPTIC FORK
SOUTHOLD, N.Y. 11971 ry~j
J TEL.: 765-1802 t OCALL X 7.4.-.VC24 .
Examined, HAIL TO:
Approved ./l 19~Permit No....2-X.....9...
Disapproved a/c J~/3~9~ _ .
44 " .
uil g Inspector)
APPLICATION FOR BUILDING PERMIT
Date 3 19 Sts'
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
s8ts 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 description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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 Town 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 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 for necessary inspectians. / b
(Signature o applicant, or nilm.
, if a corp r tion 52 7
/J77S
: l...s/ x7~ N..... .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
d°et^
Name of owner of premises /.^y.....v.T..$.
C (as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No.
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done .
M..05 ! r 4 r}. J.Vg7.T. I > v.G/c............ -
House Number y.~~Street Hamlet
County Tax Map No. 1000 Section'7.0.!. 11s.' flock ...........9....... Lot.././ . . . .
Subdivision Filed Map No. Lot...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy X,! T. e ....S/. K.Ce Ff?••et ~~y,~,(;{ 1 n! .
b. Intended use and occupancy a
_73- Nature of work (check which applicable): New Building
Repair Addition Alteration
11, Removal Demolition
Other Work..............
4. Estimated Cost 6.0.o,Q, •Y' (Description)
Fee r~f7
5. If dwelling, (to be paid on filing this application)
a, number of dwelling units Number of dwelling units on each floor .
If garage, number of cars ,
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front ._3S.' , i
I
Height ..~y Rear ,3 8• , , . , , , , . Depth 2
P...........
Number ofStories .../,2~
Dimensions of same structure with alterations or additions: Front . ,
Depth ....1(0,' Rear ..3J
• • . . . . . Height ,$q.He, , , , , , , , , , Number of Stories .
.51q.41.0 .
8. Dimensions of entire new construction: Front Rear , , . • • • • •
Height . . . . . . . . . . . . . . . Number of Stories , Depth .
9. Size of lot: Front ...~/.4i Rear W.4 Depth .
10. Date of Purchase Name of Former Owner /10 • • .
1 1. Zone or use district in which premises are situated. . • ' ' ' ' ' ' ' ' ' .
' ' ' ' ' • • ' • • • •
12. Does proposed construction violate any zoning law, ordinance or r~gulatio/ors da-vt.a. C , , , , , , , , , , .
13, Will lot be regraded yV,,,-,•
Will excess fill be re
14. Name of Owner of premises /,(.g.%/.-r 1'. p, S fi, . Address/P4?-$ /A o moved from premises: Yes No
Name of Architect Awf-y Lv.,, & e . , , • • • • Phone No..Z.P k;,g ,
• • • • ...Address At,Ar.T..irv c.(t ......Phone No...... .
Name of Contractor .1. 9,1,1 61 r;ro.4w• r c Z.• , Address • ' • ' ' '
15. Is this property within 300 feet of a tidal wetla d? v *Yes or. he rld oPhone ~.2 & No• yJ , ,7,~/~Q1
*If yes, Southold Town Trustees Permit may be required. ,
PLOT DIAGRAM
Locate clearly 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. W4 ZS' A
,
_r .
.50' APR D AS NOTED
DATE: /7 S B.P. N
_ FEE: By.
C NOTI Y BUIL ING DEPARTM
(lo `{p A /1 765.1802 9 AM TO 4 PM FOR THE
I j FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
bP GIs - FOR POURED CONCRETE
ly 2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
CODES. STATE CONSTRUCTION & ENERGY
NOT RESPONSIBLE FOR
DESIGN OR CONSTRUC77ON ERRORS
STATE OF NEW K
COU Y OF S.S '
.....5-A.....
being duly sworn, deposes and says that lie is the applicant
(Na of in ividual signing contract)
above named.
He is the p~ r
(Contractor, agent, corporate officer, cta.)
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 there ith.
Sworn to before- me this
,c(
day of 19
Notary Pub 'c, .
' County.,
CLAIRE'L 6LEW
Notary Public. State of New York .
No. 4879506 ' e of applicant)
Qualified in Suffolk County (Signature of applicant)
cant
Commission Expires December 8,18
3- Naturc of work (check which applicable): New Building • -
Repair Removal , . • Addition Alteration
OtherlVork
4. Estimated Cost (Descrition
&.a.0.Q...... , p )
Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units
If garage, number of cars . • • • ' • • Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front 3 , i
Rear ,j .
Height X Y F F........... Number of Stories ...l. 21............ Depth 2P .
Dimensions of same stricture with alterations or additions: Front
Depth....y4.' . Rear ..3.~
Height S,q,,,,te Number of Stories . .
8. Dimensions of entire new construction: Front Depth ' ' ' ' ' • • • . .
Height Rear
• • . • .N. . . . . .umber. .of. . .Stor..ks. Rear . . . . ,/./...6 .1/1-11-1111-1 ' . ' • • • • •
9. Size of lot: Front . .
./1.b . .I-- .
.
10. Date of Purchase Depth th . ./10
.
11. Zone or use district in which premises are situated • ' 'Name of Former Owner .
12. Does proposed construction violate any zoning law, ordinance or r 6ulation: `tY d -vf,<a. 1 .
13. Will lot be regraded .....NU........ • • • • •
14. Name of Owner of premises .N. - : • • Will excess fill be removed from premises: yes No
/e• ~.T. k.0. $ K f .Address/p2:75, Mr1w.Q~ • ...Phone No. 61 J?. .
Name of Architect . f' we'd La.m he • , , , .
..Address fi.Ar.T. irv c~ • • , • ..Phone No. .
Name of Contractor .1. 44JZAr•;rn,a~ t t 1r . ; . • • Address ./Q., 0.v: he . • • • • '
15. Is this property within 300 feet of a tidal wetland? * aA
Yes ••Phone 7t 7•,1.5(}7j
*If yes, Southold.Town Trustees Permit may be required, No...,.. .
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description accordutg to deed, and show street names and indicate whether
interior or corner lot.
~ s
ir S t *lop AP RO ED AS NOTED
DATE:? /7 S'
t BULL. RY:
o ( f it NOI'I Y NG DEPARTM AT
V O J'P . I / 785-1802 9 AM TO 4 PM FOR THE
V .9 FOLLOININ(i INSPECTIONS:
1 Q 1. FOUNDATION - NVO REQUIRED
p I° FOR POURED CONCRETE
2. ROUGH -
3. SUL TION AMINE & PLUMBING
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
/Ilo CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW RK =
COUNTY•OF
, • • . . O.S . being duly sworn, deposes and says that he is the applicant
(Namof in ividu al s tr
igning contract)
above named.
Ile is the .M
(Contractor, agent, corporate officer, eto.) '
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 mariner set forth in the application filed therewith.
Sworn to before me this
n ( ~
~ ei.day of C . ,
1
9.~.
Votary Pub 'c, j7
y::. E6 4, JJJCounty
CLAIRE L. 6LEW .
Notary Public, State of Now York . . '
.
No. 4879506 1 •4 •
Qualified in Suffolk County /
Commission Expires December 8,181_/ (Signature of applicant)
1 ° TOWN OF SOUTHOLD PROPERTY RECORD CARD )
OWNER STREET < -j VILLAGE MIST. SUB. LOT
FORMER WNE I E / y A 'R. ~S
1121 A 1
S/I W wt. TYPE OF BUILDING
RES. SEAS. VL. FARM COMM. CB. MILS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
4 Z,
- - - -
AGE BUILDING CONDITION
NEW NCRMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD oo G
Meadowland DEPTH
House Plot BULKHEAD
Total v DOCK
COLOR TRIM r r
V '
ry ~ \
-
- - - - - - - - - - - - - - - - - - - - - -
m~LL
1
M. Bldg.
Extension i -
Extension
Extension
wwN} f;L
Foundation Cf. Bath Dinette
Porch Basement ~C ( Floors K.
Porch Ext. Walls Interior Finish LR.
i'Ir
Breezeway Fire Place O Heat DR.
Garage Type Roof Rooms lst Floor BR.
Patio A Rooms 2nd Floor FIN. B
0. B. Dormer Driveway
Total
LWERWRITERS CERTIFICATE PENNY LIMBER
REQUIRED NORTH ROAD - BOX 1440 r
MATMCX, NY 11953
OCCUPANCY OR
USE IS UNL.A1,7FUL
WITHOUT CERTIFICATE
~ - OF OCCUPANCY
~xls - - MAY 31995
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