HomeMy WebLinkAbout32508-Z
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32112
Date: 12/29/06
THIS CERTIFIES that the building
ADDITIONS
Location of Property: 350 WEST
(HOUSE NO.)
County Tax Map No. 473889 Section 103
CREEK AVE
(STREET)
Block 11..-
CUTCHOGUE
(HAMLET)
Lot 2
SUbdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
NOVEMBER 21, 2006 pursuant to which
Building Permit No. 32508-Z
dated
NOVEMBER 21, 2006
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 KITCHEN ADDITION WITH DECK TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to CHARLES DIGNEY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
19157
03/18/98
PLUMBERS CERTIFICATION DATED
11/21/06 RBT.VANETTEN PLUMB.&HEAT
~~
Authorized Signature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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:
I. 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 I % 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 bnildings (prior to April 9, 1957) non-conforming uscs, or buildings and "pre-existing" land uses:
~ 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 $1.5.00
Date.
II /2-0 / l5&
, ,
New Construction:
Old or Pre-existing Building:
V
~V;I (i::-fi:::1L
Street
(check one)
Me
~ -AJT7.1+D61.J5
Hamlet
Location of Property:
~r:::;D
House No.
C'~U?S
IO~
DI~
Block 00 I ?J
Lot ()O ~
Owner or Owners of Property:
Suffolk County Tal' Map No 1000, Section
Subdivision
Permit No. 3 2 ~D0
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ 20. ()O
Filed Map. Lot:
Date of Permit. \\!1-l! r57J? Applicant:~-t"7 1)1'0~
Underwriters Approval:
Final Certificate:
(check one)
B...It<:-. Il5S1
c 0 ~ 3d JI J..
FORM NO. 3
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)
PERMIT NO.
32508 Z
Date NOVEMBER 21, 2006
permission is hereby granted to:
CHARLES DIGNEY
350 WEST CREEK AVE
CUTCHOGUE,NY 11935
for :
CONSTRUCT A KITCHEN ADDITION WITH DECK TO AN EXISITNG SINGLE
FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES 23955.
at premises located at
350 WEST CREEK AVE
CUTCHOGUE
County Tax Map No. 473889 Section 103
Block 0013
Lot No. 002
pursuant to application dated NOVEMBER 21, 2006 and approved by the
Building Inspector to expire on MAY 21, 2008.
Fee $
75.00
...
e
ORIGINAL
Rev. 5/8/02
..,..,... -
.u.. NO. .
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
ITHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
3").')01 ~
N?~
Dote ....o/~....................................., 19..97
Permission is hereby granted to: . .
....~....6...J.l.6:-"'(~~..........
.....3&).....td.~..CM.~(...L!cf:...............
..c.,1:r.dp.~~..7.....t.:f!/..,../l.f~
to ...~~;::..':l:......A....../iI.~:utd..r....~)L7'd.......~iit......~#.:~...m
*...~.;m':J....J;!fjtv~~~......~~...!.?ft.??;~.....~..~
at premises located at ...............................;;........................ .....~.................................................
.............................................................~~.~A..................................................................
-................................................................................................................................................................
County Tax Mop No. 1000 Section ...IQ,J............. Block .../.3.............. Lot No. ......O..L.........
pursuant to application doted ...~I!&f~......I.~.~....... 19..~.z and approved by the
Building Inspector.
Fee $.7~.=......
.....~J~"..._-".
Rev. 6/30/80
ELECTRICAL INSPECnONSERVlCE INC.
. mDllN'l'pNA~
EAST PATCHOGfJE,NeW yORJ( 11712
(516) 286-6642
DA71!::
Y/ 8/98
19157
APPLlCATIONNo. ON F1IE
YIILAGE:
Cutc/rtwIe
TOWN:
SmlthoId
ADDliESS:
:l50. WIfP.t t:'rmPk'A1.wtnur
IS8U1lD :ro:
Clrorlu Difl'leY
IN7JlODUCED BT: Rick Daniell Electric .
LIC No: .1024-E
wau'''IIIfIMdon 3-18-98 GIIIi/arllol"''''I1o~o..,_w/tht1roN_m.:trlcalCod.
LOCATION: Btuo.. In x 2Jtd 3nI AllIe
]Nt. GdnIg1I HolT.. Pool
SWFl'CHE8 RECEPTACLES F1XT/J1I1!$ FANS GFJ.
9 9 8 2
DR7ER ClOl7IES III G4Il. DI1fI'. OJIEN
FURNACE
OlL
GAS
CJR.
MIY1"OR$ BBU l'Jl4N.
8Ii:It
OTHER
EQr1lPMfN1'
Kitc1reltAddltton
1-2f/Qmp"._
~
. HUGOS. srJ1lDl
PRE3ID1!NT
BUIWING PFkM1T No.
BLUEORtolNAL YELLOW COPY PlNKCOPY OPPlCll
'IWt......_..........,......
.............-...--
".:i~!~..;;,:".,"^_
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Fax (631) 765-9502
Telephone (631) 765-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
-', 2 1 "u'r'~,
" ,,( L-
\' .,
I
I
I
___J
CERTIFICATION
Date:~N rN. ~ I
;J.oofo
Building Permit No.
J.3Q5t5'
Owner:
f\,\ \'". 1) ; {:i \'\ QJ.A .
(Please ~rint) I
Plumber: ~O b ex+- \/0..%\ F: tteo
(Please print)
I certify that the solder used in the water supply system contains less than 2/1 0 of 1%
lead.
R~ ()j('ftV ~~
(Plumbers Signature)
Sworn to before me this
t.}
day of
,,( ()J
20 Oc.
~
Notary Public, tJ1t:SA--J.
JOHN E. STUMPF
NOTARY PUBLIC. Stall 01_ Yort<
No.01ST81525S'
eo-. in _u Counly to
Co.i.IliI. 'TI'll~, ~~,Ibef 18,20_
County
3~~ 6<(;
I~-:~,- "
WARREN A. SAMBACH, SR.
CONSULTING ENGINEERS. PLANNERS
DEe I 4 '; ,6
;.
7675 COX LANE. P.O. BOX 1033
CUTCHOGUE, NY 11935
(516) 730492
--_-1
Building Department
Town of Southold
P.O. Box 179 Southold NY 11971
To Whom it May Concern
Re:
Charles Digney
350 West Creek Avwnue
Cutchogue NY 11935
BP 239552
10-300-1300-002000
Beam size, span & Briageing for Deck and Kitchen Extension
cpnforms to approvec plan$.
Sincerly,
i~(tt~ b--
Warren A. Sambach P.E.
was
.<-I"!:f.
'~. '. ':.~4;~\.
*, \1"',
~ ;, . ..
(. ~: ,:'" 1;
.JJ:':-'iJJO~
~8TA1f'
6 iA,'l\Li2-..
;(,,5- r... I S ~
! D~ - I ';;1)0')
}~5o l Z-
TOWN OF SOUTHOlD BUilDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRIJCnON
REMARKS:
[ ] ROUGH PlBG.
[ ] INSULATION
~FINAl ta ~
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRAnoN
v
I~\t/ . pp; ~ ofc~
/
~~ 04-.~\l
DATE/:;2.. ,... -;..;;...,... 0 h INSPECTOR ~. ~
3:;-5o'l z...
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING ~ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
11~:.~ ~"__"_-A' /'b..-J-:'j ,_ _~~\
REMARKS: ",:n -;-~_. rl :If 'flVT'"'7 '-C/v~_____
d- ~ d2J2~~. Et~~
~ ~v' -!vJV,
F~ ~.~V/\, 4-~
~~~iJ
DATE //~r7-t?t INSPECTOR~' p~
..~~
3~ ') G~ ~!^-/
765.1802
BUILDING DEPT.
INSPECTION
[
[ ] F NDATION 2ND
[ FRAMING
[ ] FIREPLACE & CHIMNEY
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
~
~)15~~
2:;;).:, 0 ~'
765.1802
BUILDING DEPT.
INSPECTION
[ UNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ & CHIMNEY
DATE
INSPECTOR
I
~)/c;~~
'3~')0 6
. -
765.1802
BUILDING DEPT.
INSPECTION
[~GH PLBG.
[ '1"INSULATION
[ ] FINAL
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
DATE
/J.,/g /9 7
/ /
INSPECTOR ~
765-1802
BUILDING DEPT.
SPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
~gI ~r~
~
~~
Oek
REMARKS:
-
--
DATE
f N!l1I1.^T T ON Pl~n N. '(.
r:l)lfNn^ r r ON
:;;~
:'f~
.",..
IHlIICII FItM'U-: '"
1'1.1)'1nINC
;,T ^ Tfo: IUfl~IH~Y
!:[)f)f(
(\
;:r1 "I
!~
" ~
j)\
FI NAI.
\/'
.....
O~.
F
1
^DIJ ITIOtlM. (;O'llmlrr:;:
~===~=~=~M~__~=~~~~~__=~~~~~=~=~~~__~-~====__~~a___~____~__~_==_~=~==~====_====~==~__~~==~_==~
;:r1
l'1
;':)...
",,"
:~"
t'l~
'1
.,
OWNER
r
~
'\
. -/1-;)
TOWN OF SOUTHOLD PlfOPERTY RECORD CARD
11-
t-").L( ~ =+- "4. 0 v :, .
I ee
STREET 350 VILLAGE DISTRICT SUB. LOT
fC'ree,tl2veL-C\1r /0 q" ,~/2.... ,o'e]C,
N E' ACREAGE I
()R~s.f"""~dd j4/eJfC'h'<'1I 9ve. I~
S D.J; M4.dLeoJ </-II/{ W If)-'<"ss Ie y I TYPE OF BUILDING 1
FARM COMM. I IND. I CB. .J MISe.
DATE REMARKS,g /1", flr" ,,/,'r .". /.3 3/ Z
E .:n', ;,. 0. r-e cI Co ~f- /~ () 0 d
I Est. Mkt. Value
(~o.(les U'Q(\-t\.l
FORMER OWNER :::11 .
LAND
/;2" ()
~
/r2.od
.t:;OO
goo
()()i.)O
;l-oAG.E
NEW
Farm
Tillable 1
Tillable 2
Tillable 3
Woodland
"S'warnpland
Brushland
House Plot
Total
I
SEAS.
VL.
IMP.
TOTAL
380':> /
J ~s-o
dad
, :':-3-0
-
.~ 3J2Q ..q2jO-
S'7o() /I/:!-7/
~~~9 CONDkT)9c
BELOW
NORMAL
d '/~
tv e ((I,'j c1 L
,/
Acre
Value Per Acre
Value
00"\ a OJ ".,.e (I'"
0... W~rlC"<Il4&..fiiil.[J~,fj.? r" c"
DOCK
-
l..!..:.:LLI~jll;.c:l. :~ .1") / 9 J. I'/.
... i' '"
(O~q~-LlI7%p4ftip-nu+ rs+ $by5 -to !:Jdc( "or-s. - /Ii Ie......
le/I'6i'iil'-lJ \/'60p5'l3< ht-Ie( e(VYS +D LJ~')eV '#~D~ (lfFj2
--v \
',J..
---I /..
)
RDitO
____ _____ : : i_ j
-1--- : / ' ~
-- 'I U/ ". 1'1 ~ j
:-~:= ~t _un : ;z. '1_ _~- = - ~_ uu;
_' ~ I 1
-21. ---l-'~O i !
---~tJ~~-- i]
--- t-H ---- U~I -- U~__:__:_ !
[I-H:~+-L ':- -l- cJ-=+_fji
i-r;l-i- --[_1 _~__,____+ [!.
1- tJ..lJJ-r-r+- r- -r-l-r--ir -;II_;
_~~~Idg. i l ~1..i1______~Ji>_ IM*-.8.~~!---~ r~~ndation___ L"J:h_J ~ath_ __J5h C-i-----~-----
Heat
- - - - - -- ~- ~- ~ -
,
. ~ I )r'A
- ~:~i'-;~~;-~\: ~5t~--t.~_:-:--- ~3~!tj X_f___::~~: ----- :::~~Y~s: Floor __c;;~L~_n! --------------
_Eil 1-K'i-----2------1-n----- -~ . .. _______u_______ _---.JL____1 ._______~_..._ ___
Breezeway_+ Patio Roams 2nd Floor IV 6 i1 ~ I
=~CJra~~==r- --. u_=~-=_=~= --1-~==~ ~==~~==~ Dri~~~~~-~-==--_=~<>r~e;=-----~_~-~ ~ )~_~I-=-=_-=:_----
o. B. 1-------379-3-1' ----________ . ______ j
--- _..b
'-/1'/1 ~
"~~1'''''
?iI's
vL.'9'
-.-::~
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~
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,
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..J
FORM NO. 1
TOWN OF SOUTHOI.D
BUILDING DEP^RTMENT
TOWN II^LL
SOUTlIOLD, N.Y. 11971
TEL: 765-IR02
RO^RD OF IIE^LTII ...............
~ /1 SETS OF PI.J\NS ...............
/SURVEY ........................
/CIIECR .........................
SEPTIC FORM ...................
r~ ~ @ ~ l~n 'c
\,L' FEB,: I,-,q(
t 1 ~
\ BLDG. DEPT,
TOWN OF 8OlJfHOLD
Exanined.....3/t:..... 199.7.
^pproved.....3!y.... 19:};
Di "'"1JlProved olc ..................................
~~~ U1s
Permit tb. ~~...
NOTI FY:
~/G -7r.S-(;/stj
C^L1. ..................
M^I1. TO:....................
........................................:::A~.P;. iI.....
(IlJild~;t;Z~
^PPI.IC^TTON FOR BUI1.DING PERMIT
Date. .fi.6.. /9..... .199.7.
I NSTRIICTIONS
,
a. 11,is application IlIJ8t be """,Ietely filled in by typewriter or in ink and md..itted to the Il,ilding Inspector with
3 sets of plans. accurate plot plan to scale. Fee according to schedule.
. b. Plot plan siDling location of lot and of buildings on prenises. relationship to adjoining prenises or ""hI ic
streets or areas, and giving a detailed description of layout of property lIlL~t be drawn on the diagran ""ich is part of
this application.
c. n", work covered by this application my not be L....".""''''J before issuance of llJilding Permit.
d. Upon approval of this application, tl", fuilding Inspector ..ill issue' a llJilding Permit to the applicant. Sud,
permit shall be kept on the premises available for inspection throughout the work.
e. tb' building shall be occupied or u..ro in "101e or in part fur any purpose ""atever ootil a Certificate of
Occupancy shall have been granted by tl", fuilding Inspector.
M'PLlc.\TI<ll IS IEREIIY twE to the IlJilding \Jepart1ll!t1t for the issuance of a llJilding Permit ""rStJant to tl",
Il,ilding Zone Ordinance of the Tom of SoutllOld. Suffolk llimty. New York, and other applicable Laws. Ordinances or
Regulations. for the con.~truction of buildings. additions or alterations. or for t'6IDVal or detrolition. as herein
described. n", ,8JlP,' licant agrees to """'I, y, w, "ith all applicable laws. ~. s. building code. 11OlI8ing code. and
regulations. r . thorized inspect,ors on prenises and in bui . for """".s~1J'i~" .
. 1m . ~ ,ii:',;,;,.;;..;.., ';;Y;;;;~;';;;';;;;i;;;
I s;u. jl. 9.s.cUf!~r.:C!!~f1::./!Y.f..(!t!T.{!jjP.(itJ.(.1!1
" ~ _ (Hailing address of applicant) n9.3S
I OF . DEPT.
State whether aW1icmt 18 ~~~H'fUl.ee~..JPgeTlt, ardl.itect, engineer, general contractor, electrician, plumer or b.Jilder.
..... .QI1-!.N.ti:~....................................................................................................
"'"'"' of owner of prenises ... r/-.<<.IJ. ~ S.~~...F. . ()/6,I-I.tf' ..Y...................................................
(as on tI", tax roll or latest <k>ed)
If applicant is a corporation. signature of duly autllOri?ed officer.
.............114.......................................
(Mane and title of corporate officer)
llJilders License tb.
Phm>eTS License N:J.
Electricians l.icense No. u. .... ....... u.....
OtJ",r Trade's License tb. .....................
I. l.ocation of land on ",ich 1'<UI"sed work will l1E! done..............................................................
.... .~5C:............ .o/t.~7:.. ~~E.~. .!!f.-f:...... .r:;~r:t;';{(~. .6.<<?..........................................
Bouse IUlber Street llanlet
CamtyTaxttJptb.llXXl Section {R.3.Q.Q....... RInck l3.~.........lot .Q.Q.?:-.t?9.CJ..
Subdivision ...................................... Filed Hap No. ............... lot ...............
("'"'"' )
2. State existing u.~ and occupancy of prenises and intended use and occupancy of proposed construction:
a. Existing lL~ and occupancy ........ J.tA/.. e../... /.I!.cf::: .. . . . . . . . .. . . . . . . . .. . . .. . .. . .. .. .. . . . . . .. . . . . . .
b. Intended use and occupancy ........ 7).11< tf.<f.t AI. 6...................................................
.-----
'I.
Addition .../..... Alteratio~' ..........
olhec l-Iork ........~.&.:H....................
(llescClption)
"'''lure of IoOrk (check ..hieh
I~'l",ic ............ Ra10val
al~)1 icul>le):
ti.."\.I Uui lding ..........
IlaInl i tion ............
. . ~ . . . . . . . . . .
I,.
Estimuted Cost ... /.~.t1':P.............
5.
fee ........................ -.. ~"':.W-~.3::"'."'"
(to be paid on filinrr"lhiJ\aM~i&)
If ch..lellill8, ....lber of ck.Ielling tUlils ..1........ tl.llher of. (}..Jelling lUlits (XI ead, floor ../.............
If garngc, ,ulj>er of cars ....Jtj,p,..............................
"If husiness, canner-cia} or mixed occupancy, specify nature arKI extent of each type of use...4'/4...............
, . f" 'f" . Il/.l Re //," lle'11111/11
lJllllenslOJls 0 existing stnlCtures, I any: a:ronl................ ar- ..:ri.......... pL' .d-.1..f:f..........
lluight ..... /.~.:.............. !'loll.,,, of Stories......J............... t)( /
l>imensiofls of slIre 8tnJCL1Jre with alter-stions or additiCX1S: Fr-oot ...sGz,.l?...~. Rear ....t4:~.......
IlepLh .. .'k.'f.~ .6.-;........ lie/gilt .t.f. ~.............. !'lod",c of Stories..t............
Il. . f . . I' ,L I I '" I'~ / / 1 (7 II lle I 14'",0
)lIIemilOus 0 enUre new CClClstnICl:Jou:ront .. .;:!..~....... \Car ..::l........... pll..............
IleiBht ..... II..~............... !'lall",c of SLories ...... J.,........... I
Size of 10L: I'tWL ....'f.~.i,.~f..:... l!ellr ....Y.".3K:,$.:?~.... I"plh ...I.f.:).,...........
I~lle of l\m,hIlBe Jd It! ;.~......... Ilia.., of ('orner Ck.n>ec k II. .7/I1!.Y~ .. r.:J .(:,:?I.-:... . ... ,
6.
7.
8,
9,
Ill.
II.
12.
IJ.
Ill.
.
Z.oue or use distdct in '",hid, pldUi6e8 .or-e situated ..............................................................
Oues (lr-opotied constntCLion violate any zoning h&.l',' ordinance or regulation: ..~f...................
Will lot be regraded .../.rR............. Will el({'ess filii", caloved fcanl"aniS<jB: YES III
Nales of lMt>er of rcaniBes C#.JtZ?'o. .C!:>lG.lAt.. flddreBs 3.s?'.. ~?~T. /!fY.o!fi;. (!(~:. ~~:'jf~~1b:16S:':l?4....
.
15.
Nme of Archiled .................................... Mdress .............................. Phone lb.
Nme of r.ontcactor ................................... "'klress .............................. .HIOOe lb.
Is this property wilhin 300 feel of a tidal "",,181.11 * YI~ .. /...,.. Ill..........
*IF YES, flllllllD ml'l TIlIlSIEI!S l'I!l~1T tl<\Y IlIlllllf~IIIU),
nOT IlTAGIlAH
l.ocale clearly and distinctly all huildings, Ylelher existing or proposed, and
hcn propel"ty lines. Give street and block l'I..Ilher or descdpticxl acc~rding to deed,
lA.ether in.edor or corner lot.
SE~ /I-r-;IIC/lEj)
indicate all set-back diuEnsions
ill Bi~S a~1 i~licate
_tie
r-:'.
",::'l~, ,.__
<,~ v~.~.
ST/(!E (~, II'W YI~U<,
. ~t/~F'" LZ
(HINIY LX' . U . .. . . . . .. .. . . . . . . . . .
.....C.#.1.IZ.c:...t:=:r..r.....1>.ICAJel.........,...,...hcill/J dilly S\.I{llll. delXlBeS 81.1 Bays Lhllt he is the spplieallt
(Nalle of ilKlividual signillg contract)
illxJVe 0,(11(."(1.
(r,onlraclor I nuent, c:oqxlrute offker Jete.)
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appl i(:atiollj lhnt ull staleneuts cOlltained in this appl icution are true lo lhe best of his knowledge and I>l!lief; {lnd
that the wurk wi II he perfonued in the manner set forLh in Lhe appl icatioll fUed therewith.
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CERTIFIED TO:
CHARLES D I GNEY
FIRST AMERICAN TITLE INSURANCE COMPANY
OF NEW YORK 151-S-2132
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SURVEY
CHARLES DIGNEY
AT CUTCHOGUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000 - 103 - 13 - 02
Scale: 1" =50'
June 10, 1996
June II, 1996 (Revlslonl
FOR
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..,.'~ ALTUfATION ~ ADOITION ro THIS 5Lf1~ IS A VIOLATION
"OF, SECTION 7209 OF THE NEW l'tWK STAre E:tJIJC.4T1ON LAW
iE:XCE1'T AS PE:R SECTION 7209-SUJDIVISION 2, ALL CEJ1T1hCATIONS
'" ~ ~ VALID F~ THIS MAP.AND Ca"IES THE:REOF ONLY IF
",:SAID MAP ~C1)PIES BEAR THE IAFRf:SSED SEAL OF THE 5Lf1~
' i" IIP10SE S I fiNA 'T1.Rf:: APPE:ARS HEREON.
'. ii""~ '<
',""ADOITICNALLY ro mA.Y WITH SAID LAW THE TERJJ "ALTERf:IJ BY'
HIJST BE USED BY ANY ,AM) ALL ~S I.ffILlZING A copy
:<~OF NIOTHER ~'S MAP. Tf'11US SUCH AS "INSPECW' ,AM)
!;~;'!fW6HT-ro-DAre' ARE NOT IN cr:wLIANCE WITH THE LAW.
'". ',.
X:~_::(;.~:
'>t}!':
ECONIC YORS,
(516) 765 - 5020
P. O. BOX 909
1230 TRAVELER STREET
SOUTHOLD, N.Y. 11971
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