HomeMy WebLinkAbout33055-Z
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 07/02/07
No: Z-32442
THIS CERTIFIES that the building INGROUND SWIMMING POOL
Location of Property: 625 EUGENES
(HOUSE NO.)
County Tax Map No. 473889 Section 97
RD
(STREET)
Block 2
CUTCHOGUE
(HAMLET)
Lot 16.2
subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
MAY 21, 2007 pursuant to which
Building Permit No. 33055-Z
dated
MAY 21, 2007
was issuedt and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is ACCESSORY INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD WITH FENCE
TO CODE AS APPLIED FOR.
The certificate is issued to JOHN A & DIANE N GRAEB
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N-316763
06/09/94
PLUMBERS CERTIFICATION DATED
N/A
~ 4:a~
Au rized Signature
Rev. 1/81
M-~
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BJ:i~g~~~~~~i~T Ii! G)( U n _, IV '~I~' '
TOWN HALL LU \ 2 7' J U I
765-1802 I, ,
APPLICATION FOR CERTIFICATE OF OCCUPAliicx....l'!'W~'8F~~g~~o:1_1
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
.
A. For new bnilding or new nse:
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 trom plumber certifying that the solder used in system contains less than 2/1 0 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 uses, or buildings and "pre-existing" land uses:
I. 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
Date. ~ Iz. 7 It] 7
( (
New Construction:
Location of Property: ~ 2-5
House No.
Old or Pre-existing Building:
/'
( check one)
eu IC 1+ 0 6 LU:=
Hamlet
t=:.Lt6-et-.iG-S R-O.
Street
Owner or Owners of Property: :ro,+(\..\ .(. 1)1 A-I-iE GRkEB
Suffolk County Tax Map No 1000, Section 473g&Q-cJ'7'7 Block ODD z...
Lot 0 I te. . 00 2..
Subdivision
Filed Map.
Date of Permit S- ! 2-1 107 Applicant:
Underwriters Approval:
Lot:
Permit No. 3 '3 0 ~ :;
.TOI+C\l; (..,.I<k~r3
Health Dept Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ · Z ~
Final Certificate:
C-- o.
~ (check one)
A~4!P'
~.11~.2t
\2.0...t:: 2;1.;2. L[Y\2.
5:?o.>57-.
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] ROUGH PLBG.
[ ] INSULATION
~FINAL ~:
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
~ ole,
] FOUNDATION 1 ST
] FOUNDATION 2ND
] FRAMING I STRAPPING
] FIREPLACE & CHIMNEY
] FIRE RESISTANT CONSTRUCTION
j>n,( ~A
F~ ~, ~ &1<
t=~~
~~~I
REMARKS:
,,.-~ -I) 1
DATE
.
INSPECTOR~ ~
-.---.------ 'Z.19~~--
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1185077 BUREAU OF ELECTRICITY
I . 85 JOHN STREET. NEW YORK. NEW YORK 10038
Datp Jj.ooi (J9,199<1 Application No. onJilp 8447489<1/9,~ N 316763
THIS CERTIFIES THAT
only the electric. equipment 08 daeribecl below and iRtroduced by the applicant named on the above applicatiora Rumber in the premises oj
JOHN GRAEB, 625 EUGENE ROAD, CUTCHOGUE, N.Y.
in theJollorring location; [!J Buement o /otFI. o 2nd n OUT Sfftion Block Lot
..,/ JUNE 08,1994 and found to be in compliance with the National Electrical Code.
K'fIS exam'R on
FlXTURI I FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS KEPTACUS SWITCHES INCANDESCEN T flUORESCENT OTHER AMT. I(.W. AMT. K.W. AMT. K.W. AMT K.W, AMT. H. P.
1 1 1 1
DRYERS FURNACE MOTORS PUTURI APPLIANCE FEEDERS SPICIAL RIC'PT TIME CLOCKS lEU UNIT HIATERS MULn.ouTLET DIMMERS
OIL TRANS. SYSTEMS
AMT. K.W. H.P. GAS H.P, AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. AMT. H.P. NO. OF FElT AMT. WATTS
SlRVICS DISCONNECT NO. OF S E R V I C E
MITIR NO. Of' CC. CONO. A.W.G. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP. l.l2W 1,3w 363W 3".W PER' OF CC. CONO. HO. OF HI-lEG Of' HHEG NO, OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
SWIMMING POOL-1
TIME CLOCKS 40 AlIP-1
G.F.C.I.-1
G.F.C.I,-2
* (SWIHMING POOL) This certificate
covers compliance at the date of
Mlspection only. Because of unusual
environments it is advisable to ~~..,(
have frequent test/and or repairs
<<< Continued on Page 2 >:-;>
_ MANAGH
Per.
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
,
----'-- - -- -.- - ~.._--- --_._-
-- ~\9 '1~--------------
THE NEW YORK aOARD OF FIRE UNDERWRITERS PAGE 2
1185077 BUREAU OF ELECTRICITY
I . 85 JOHN STREET. NEW YORK. NEW YORK 10038
Dare ,JUNE' 09,1994 Application No. onfifp 84474894/94 N 316763
.'
THIS CERTIFIES THAT
only the electrical equipmen.t cu: deaeribed beloUl and introduced by the opplicont RGmed' on the above application number in the premises oj
,TOliN GRAEB, 625 EUGENE ROAD, CUTCHOGUE, N.Y.
in thefollowin" locaYffNE [!J 89<.pmenr. D /R. Ft. D 2nd Fl. OUT Sertion Block Lo.
. 08,1 94 and found to be in compliance with the National Electrical Code.
tCOa exomlnM on
P1XTUIE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ICEPTAClIS SWITCHES INCANDESCENT flUORESCENT OTHER IoMT. l.W, IoMT. ICW. IoMT. k.W. 10M' l.W. IoMT. H. P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SHOAL lEe'PI TIME CLOCKS BIll UNIT HEATERS MULTI.OUTLET DIMMERS
TRANS. SYSTEMS
IoMT. l.W. Oil H. P. GAS H.P. IoMT. NO. A.W.G. IoMT. IoMP. "'T. IoMPS. IoMT H.P. NO. OF FEET 10M'. WATTS
SERVICE DISCONNECT NO. Of S E R V I C E
MITIR NO. OF ce. CONO. A.W.G. A.W.G. NO. Of NEUTRALS A,W.G.
IoMT. IoMP. TTPl! EQUIP. 1.17W 1113W 3JI 3W 3....w ..RI Of CC. COND. NO_ OF HI.lEG Of Hl-lEG OF NEUTRAL
OTHER APPARATUS:
made by a qualified pel-son.
-
ROSLAK ELECTRIC LIC.#3677-E ~~cr(
P.O. BOX 164
CUTCHOGUE , NY, 11935 _AI. MANAGlR
11
p"
This certificate must not be altered in any manner; return to the office of the Board if incorred. Inspedors may be identified by their credentials.
. . 2~~~"~~__!_!..L.!'__..'..~~_':.!......!...:.!",..!......!_~ .,r. .' 1.<"").' .\ '.' I.' I. .' I."" f. .' ,.,'/.< f.\ .\ '.' '.' '.' r. '.' r.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
33>()sS"Z-.
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
~
~
E~' ~, ~'-cQ.>
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRlICnON
f~
REMARKS:
[ ] ROUGH PLBG.
[ ] INSULATION
~i:INAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
~ 1;;;
,
. --d~
~
,.
DATE S-()-~ ~O 7
INSPECTOR
*,~
r'-":[:';;-~"'c"'~-~'(J'l --"'.' 1It)'M II
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rOUllDATION ( 15 t) ""u
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rOUHDATIOl1 (2nd)
2.
rz=
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ROUGH FRAHE & l\
.PLUNBING ~
.. ,
en
3. E~
IIISULATION PER N. Y. ..
, ~
STATE ENERGY , ,
CODE ,
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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.
33055 Z
Date MAY
21, 2007
Permission is hereby granted to:
JOHN A & DIANE N GRAEB
625 EUGENE RD
CUTCHOGUE,NY 11935
for ,
INSTALL AN IN-GROUND SWIMMING POOL IN THE REAR YARD AS APPLIED
FOR. THIS PERMIT REPLACES BP # 21994
at premises located at
625 EUGENES RD
CUTCHOGUE
County Tax Map No. 473889 Section 097
Block 0002
Lot No. 016.002
pursuant to application dated MAY 21, 2007 and approved by the
Building Inspector to expire on NOVEMBER 21, 2008.
Fee $
150.00
~.. ;'J /74
~.-.!L ~
( Authorized Signature
ORIGINAL
Rev. 5/8/02
~-~I?:~""f"'-"""-
=,c....tI'iI~'f'~':. 'U
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/ 000 - 9 7 - 2 -
OWNER
U
TOWN OF SOUTHOLD PROPERTY RECORD CARD
/6,,2. -re
STREET 2. VILLAGE DIST. SUB.
/
,
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.T Gro.e. b oj. (N.J,
FORMER OWNER
LOT
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IMP.
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( VL. FARM COMM.
TOTAL DATE
'2 J)a.sCRJ eE.
ACR.
.92
TYPE OF BUILDING
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Mkt. Value
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RESZ 0
LAND
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FORM NO.1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765.1802
Examined. . . . ?/:?:.. . . ., 199,0
Approved. . . :ij!.:r. . . . . ., I 97.)4ennit No. ?/. 1?1f. ~
Disapproved alc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . .
. . .. . . . .. . . .. .. . .. .. .. . .. . . . . . .. . 41Z2~;; . . . . . .
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
80~~D OF HEALTH .........
J SETS OF PLA~S .........
SURVEy..................
CHCCK ...................
SCPTIC FOR" ............._
l:%~:. 7:ff: .~(!!-........
HAIL TO:
. . . . . . . . . . . . . . . . . . .
. . . . . . ~ . . . . . . . . . . . .
, ,
Date . ~/..........., 19!Y
, a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets 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
0.. 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 neces~~~Z:~,. .uz:L . . . . . '. . .. . . . . . . . . . . .
-- , OCCUPANCY OR (Signature of applicant, or name, if a corporation)
USE IS UNLAWFUL
WITHOUT CERTIFICATE
:?Q .~Qf.. 1:. . Lkha'!-:,ihf... .&Y. .//~3:;-:.. . .f--
(Mailing address of applicant)
State whether applicaOfs QCCUPsANC~t, architect, engineer, general contractor, electrician, plumber or builder.
..,.. . .._i'''o''~r . . . ... .. . .~.:.:",= .. ... . ... . .. . .. .. . . ..iA.J,;%If :t~r:.<"
Name of owner of premIses . :::s;'*'0.................. 4rt"+'i'-b......... 'FE!:'" .'...... BY~ .A..};. ..
, (as on the tax roll or lateSflO~ BUILDING DEPARTMENT AT
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
,. FOUNDATION. TWO REQUIRED
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 N.Y.
STATE CONSTRUCTION " ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
If applicant is a corporation, signature of duly authoriied officer.
. ........ ..... ... ...... ..... ..,.... ...... .......
(Name and title of Corporate officer)
UNDERWRITERS CERTIFICATE
REQUIRED
Builder's License No. ./.?,/??-;-.H.."c.........
Plumber's License No. ................. '.1MMEDIATEL V"
EI t" 'L' N ENCLOSE POOL TO CODl
ec nClan s Icense o. .................... "UPON COMPL.ET1ON
Other Trade's License No. ................... ~~FORE ''WATER'' ,
I. Location of land on which proposed work will be done. ................................;................
... J::2.~................ .Ev.~er;t.u..'5... .7~................. .ltkh.Q~~............."
House NUI11 ber . Street, Hamlet
County Tax Map No. 1000 Section...:Y 7......... Block.....:J........:... Lot.. ./,!;..;?.......
Subdivision. :;s.()\':'n ,"'~N.,-,.. .4r.0~.b... ., ; .. . .. Filed Map No. .............. Lot...............
. m=~. .'
2, State existing use and occupancy of premises and intended use and occupancy of proposed construction:
E . . ,,', - d ~ //^~ .
a. XIS lIng use and occupancy .<;/.rU.. ~^Ij' . . . . .<I-le. 1M."",. . . . ... . . . . . . . . . . . . . . . . . . . _ . ., . . . . . . . . . . .'.
b. Intended use and occupancy ar.I..R.... .-I'.~;+ 'J/-L)~/!,.r.I~. . .~~ .:. 6.uimQ;J.;(1~.. ~~~<';(I,,,, . . . . . .
9.
10.
II.
12.
13.
14.
3. Nature of work (check which applicable): New Building. . . . . . . . . . Addition. .. . . . . . . . ~i9n. ... ... . : . .
Rep3.1r .............. Removal.............. Demolition .............. ~ ~~'.'!1fl:'j (l~"M\
;0. . .. .. . (Description)
4. Estimated Cos~%~:0? . . . . . . . . . .' . . . . . . . . . . . . . . . . " Fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
5. If dwelling, number of dwelling units. . . /. : . . . . . . . . '. Number of dwelling units on each floor. . . . . . . . . . . . . . . .
. If garage, number of cars ........................ 0 . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . 00. . 0 . . . .
6. If business, commercial or mixed occupancy, specif~~ture and extent o. fe~h type of use . . . . . . . . . . . . . . . . . . . . .
7 D. . /... . I R 1'1 I ;, / 3 I
. unenslons 0 eXlstmg structures, If any: Front. '1. . . . . . . . . " ear. ..-:.......... Depth --<u.'. . . . . . . . .
Height . ~/. . . . . . . . . . . Number of Stories. ./.. . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front ................. Rear................ 0 .
Depth. . .. '. .'. . . . . . . . . . 0 . . .. . Height.. . . . . . . . . :. . . . . . . . ,. . Number of Stories. . . . . . o. . .. : .. . . . . . . . .
8. Dimensions of entire new construction: Front 0 . . . . . . . . . . . 0 . .. Rear . . . . . . . . 0 . . . . . . Depth . 0 . . . . . 0 . . . . . . .
Height " 0 . 0 . . . . . 0 . . . . Number of Stories. . . . .. . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . 0 . . :0 . . <' .... ,.. .
Size "flat. Front. .t3Kf............:.. Rear.. .1.$;;::.............. Depth .30~.'... 0....... .':..'.
Date of Purchase .. 0 . . . . . . . . . . . . . . . . .. . . . 0 . . . . Name of former Owner ..... 0 . . . . . . 0 . . . . 0 . . . . . . . . . . .
Zone or use district in which premises are situate~I~:\cJ'i'-.\. . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . ~ . . . . . . .
Docs proposed constrystion violate any zoning law, ordinance or regulation: . po. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Will lot be regraded .Y:e.~...:.................... Will excess fill be removed from premises: cg@ No
Name of Owner of premises ~\.:>{l.l~~ 4l~... Address .4<'~..f':Vf1';'~ ~",q>hone No. ?.!fr..,. 7.3.2'7:... .
Name of Architect . A . . . . . . . . . . . . . . . . . . . .. . . . Address. . . . . . . . . . . . . . . 0 . . . Phone No. " 0 . . . . . .. .'. . . .
Name of Contractor ~ aM.74I. ~.... . . . . . . . Address~ ~ .~.~#~3~ . . . Phon..~ No. 7.a~- :S:7.J.':?-. . . . .
Is this property within 300 feet of a tidal wetland? *yes........ No.~...... I
*If yes,Southold Town Trustees Permit may be required.
PLOT DIAGRAM
15.
Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate ail 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. . .
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STATEOFNE\\!:::YO,RriD_~'S'S, _ .;,_" ".. .
COUNT OF.. ~.~ .. ~J31Ai'd.:;~J1p,~I. .
...... fu~.~.. ", ,...t...o. ~1O~g{f,,'.iJh.().~{!~N@;J8.., ~!uly sworn, deposes and says that he is the applicant
(Narfj of mdlVIdual slgmng contractniEC' 'ST ;'...;':.;a . . .
above named. .
Ile is the. . . . . . . . . . . . . . . . . . . 0 . . . . .. ;". . ....;..~. . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . . 0 . . . . . .
. (Contract r, agent, corporate officer, etc.)
of said owner or owners. and is duly au 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 therewith. '
Sworn to bef^ (
,~;:;;:;.[~~:1~ . .... pr~::"~~. 9.1. . .... . ../.' ~/6( /.', .
CLAIRELGLEW . ./'.... . . '--'? /'//. h..
Notary~~~~~~~NewYOrlly.~" C>..i{'ko~.' ~..... .i.-d~ (Sig~~~~6i~;;li~;;t).
Quallfled in Suffolk County
c.....mlsllon Explr.. December'" '1_
.
';
THE LOCATION OF WElLS .l:ND CESSPOOLS SHOWN HEREON ARE FROIlf FIELO
OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS
THE WATER SUPPLY AND SEWAGE: DISPOSAL SYSTEMS FOR THIS RESIDENCE
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMEN
OF HEALTH SERVICES
APPLlCANT,_ .'
ADDRESS_ _ ===--=- -=- _--=--=- -=- _-_-TEL:=.=_-=
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LE NO 01'-79720
7 F:: q 02
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GRAVEL
OCCUPANCY OR
14.0 USE IS UNLAWFU[
WITHOUT CERTIFICATE
OF OCCUPANCY
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ENCLOSE POOL TO CODe
UPON COMPLETION
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REVISIONS
YOUNG & YOUNG
400 OSTRANDER AVENUE, R1VERHE.AD, NEW YORK
AUG.31,1975
SEPT. 13, 1975
ALDEN w. YOUNG
PROFESSION....L ENGlNEER ....ND
LAND SURVEYOR. N.Y.S. LIC. NO. 12.!1"!l
HOWARD "N. YOUNG
L....ND SURVEYOR
1'1.1'.&, LlC. NO. "!HUt:J
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"~~UTHOIllnD ~L.'ER~T10N OR AODOTION TO
"HIS 3UR'/H 'S a viOLaTION O~ SECTION
'209 O~ THt NEW YORK STAn EOUCATlON
~A....
SURVEY FOR;
GORDON STU881NGS 8 DALE STU88INGS
Cv~'[S O' TH15 su~"u ....P Nc'T B[o~'~G
TH[ LA~O SJ~"FH'~'S '~'Ec' SEAL /}R
E"Bv<~F~, s~", ,HAcC ~C,T~, CON,'Df"EQ
TO BE " I'~L_'~ TRlIE Ceo
AT
CUTCHOGUE
GUARANTEED TO:
AMERICAN TITLE INSURANCE Co.
SOUTHOLO SAVINGS BANK
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TOWN OF
SOUTHOLO
SUFFOLK CO.. N. Y.
I":'" t.&. (, DATE IJUG. '3, 1976
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