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HomeMy WebLinkAbout35684-ZFORM NO o 4 TOWN OF SOUTHOLD BUILDING DEP~-RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34521 Rte: 08/25/10 THIS c~KTIFIES that the building SWIMMING POOL Location of Property: 395 HENRY'S LA (HOUSE NO.) Co%ulty Ta~ Map No. 473889 Section 74 Subdivision PECONIC STREET) (HAMLET) Block 1 Lot 19 Filed Map No. Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 21, 2010 pursuant to which Building Pexmlt NO. 35684-Z dated JULY 1, 2010 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 ACCESSORY ABOVE GROUND SWIMMING POOL AS APPLIED FOR. The certificate is issued to MICHAEL R & RENEE M HARVEY (OWNER) of the aforesaid building. SUFFOLK COI]NTYDEPARTMENTOFHEALTHAP~O~KAT~ N/A RT.R~-rKICAL CERTIFICATE NO. 35684 07/21/10 FL~E~ CERTIFICATION DA'£~ N/A ~Au/~/Si~ure Rev. 1/81 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. 35684 Z Date JULY 1, 2010 Permission is hereby granted to: M & R HARVEY 395 HENRY'S LANE PECONIC,NY 11958 for : INSTALLATION OF A/q A]3OVE GROUND SWIMMING POOL, FENCED TO CODE at premises located at County Tax Map No. 473889 Section 074 pursuant to application dated JUNE Building Inspector to expire on JAAVJARY 395 HENRY'S LA PECONIC Block 0001 Lot No. 019 21, 2010 and approved by the 1, 2012. Fee $ 250.00 Signature ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 .2. APPLICATION FOR CERTIFICATE OF OCClffPA/qCy This appliCation mu~t be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new buildlnoo or new use: "1. Final. survoy 0fproperty with accurate location of all buildings, property lines, s~ets, and unusual natural or topographic features. Fired Approval from Health Dept. of water supply and sewerage-disposa] (S-9 form). Approval of electrical installatiOn from Board of Fire Underwriters. . o f Code Comptianco from arohifect, o~ engineer responsible for the building. '6. Submit Planning Board Approval of~.,omPleted site' plan requirements' "B..For exi~Ong.building~.(prior to April 9, 195'/) non. conforming uses, or Imildlngs and ~'pro.exisilng" land uses: 1. Accurate survey of property, showing all property lines streets, building and unusual natuial 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 ~vriting to the applicant. Co Fees 1. Certificate of 0ccupancy - New dwelling $25.00, Additions to dwelling $25.00, Alteratiuns to dwelling $25.00' Swimm~lg pool $25.00, A~ssory building $25.00, Additions to accessory building ~25.00, Businesses $50.00. 2. CeP"ifmateofOocupancyonPre-~xisting Building - $t00.00 3. ' Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Ocoupancy - Residential $15.00, Commercial $15.00 Sworn statement fromplumber exmifying that the solder used in syatem contalm le,~ than 2/t0 of 1% lead.. CommolDial building, industrial building, multiple ~sidenees and $imilaI' buildings and installations, a Certificate · New ConStruction: Loehti0n of Pro[nmy: (check One) Old or Pre-existing Building: H nn y s House No. Street -8..uffglkCo~ntyTax. MapNo lO00, Section.' ' 7i// · Bl0ek. '.': '/ Lot . Subdivision Request for: Temporary Certificate :Date 0f Permit. Hamlet Fee Submitted: $ Applicant Signature Filed Map....' Lot: Town 1 lall Annex ,5 t375 Main Road P.O. Box 1179 Southold, NY 11971-09.5[~ TeltTphonc (631) 763-1802 Fax ((331) 765-9502 ro.qer, richert~,,town.southold, ny. us BI III,DIN(; I)EPARTMENT TOWN OF $OUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: M&R Harvey Address: 395 Henry Lane City: Peconic St: NY Zip: 11958 Building Permit #: 35684 Section: Block: Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Wilcenski Elec License No: 4723-me SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Servicelph ~ Heat ~ DuplecRecpt ~ Service 3 ph Hot Water GFCI Recpt Main Panel NC Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling Fixtures [E~ HID Fixtures Wall Fixtures ~ Smoke Detectors Recessed Fixtures ~ CO Detectors Fluorescent Fixture ~.~ Pumps Emergency Fixtures[.~ Time Clocks Exit Fixtures ~ TVSS above 9round pool including bonding, I recpticle and 1 switch Notes: Inspector Signature: Date: July 21 2010 81-Cert Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~'"ELECTRICAL (FINAL) DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING / STRAPPING [ ~I:~AL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAr,', f INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMEN TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502- SoutholdTown.NorthFork., JUN 2 1 2010 BLDG. DEPT. TOWN OF SOUTHOLO ~ZvHT NO. Examined ,20 Approved 20 __ Disapproved a/c Expiration ,20 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans ~-~-' ~ Planning Board approval ~ Survey ,~,~% ~ Che~'~"_~ 4 (I D 0 ') Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ,20 IO a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 or areas, and waterways. ,. 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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work auttiorized has not commenced within 12 months at~er the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. 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 promises and in building for necessary inspections. (Signature ofal~plicant o[/hame, ifa corporation) (Mailing address 'of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name ofowner ofpremises }kqlCk~.4 I .~ ~en~7e /'-]0,t~/x° Y (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. ElectficiansLicenseNo. Other Trade'sLicenseNo. 1. L~t~__n of land on whicl} proposed work will be done:Men, ~/'b H--otise- Number ' 'stree{ - ' Hamlet County Tax Map No. 1000 Section 7t/t Block / Lot /9 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use a, yLd occup.~a,n, cy ofprooosed construction: a. Existinguseandoccupancy Or~ ~,t,I ~'~,~ ~d~?!~ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building_ Repair Removal Demolition Estimated Cost Fee If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work IQ _f'~t~, ("~,~,,d ~-.-- (Description) (To be paid on filing this application) 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 Height. Number of Stories Rear _Depth Dimensions of same structure with alterations or additions: Front Depth. Height Number of Stories 8. Dimensions of entire new construction: Front ]~'~t/ o~/' Pl~earI .Depth -- Height ~ '~ Number of Stories Rear 9. Size of lot: Front 10. Date of Purchase Rear .Depth Name ofFormer Owner ~&~3J~t~ i /0f}' ~ll',~k'-~- 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO/~ 13. Will lot be re-graded? YES__ NO F Will excess fill be removed from premises? YES NO__ 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO )~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. __NO 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES__ NO./~ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF~--/~ J~(-~ S)S: ~-~ e_.~-~-'~. [c-~r" v' e.t.4 ' , beingdulysworn, deposesandsaysthat(s)heistheapplicant (Name of individuaI signing co that) abo; e 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 knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this dayof ~'~- bo~-- 20 to VlOKI 'lOTH Notary Public -' N~J'~J['I'~6190696 .... S plicant ., Qualified in Suffo k County ~ ~'Om~S~;~Jr'~ Expires July 28, 2D ~ ~ Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.I~ ~. THE FOLLOWING ACTIONS ~AY REQUIRE THE SUBMISSION OF A /§~ 7~/ / / ~ 8TORN-WATEI~ GRADING, DRAINAGE AND EROSION CONTROL PLAN ms~,~.t secuofl .~.K Lo~ CII~KTIFIE:D BY A DESIGN PROFESSIOHAL IN THE STATE OF NEW YORK. SCOPE OFWORK - PROPOSED CONSTRUe'LION rt'~2VI # / WORK ASSESSMENT I Yes No a. What is the Total Ama of the Project Parcels? I Will this Project Retain All St0mI-Water RumOff (Include Total Area of ell Pamels located within Generated by a Two (2') Inch Rainfall on Site? the Scope of Wod~ for Proposud Constmction) b. What is the Total Ama of Land Clearing (S.F. / Acres) (This item will include all mn-off created by site cleadng and/or constmciton,aclJvffies as well as all aed/or Ground Disturbance for the proposal Site Improvements and the pem~anent cma~on of conslmclfon activity? impervious surfaces.) (s.F.,,~,) 2 Does the Site Plan and/or Survey Show AIl Proposad PRO'~II)E BRIF_,~ l~OJ'~-~ Dff, SC~/J'J'ION (Pm~ldeA~m~.t4e~d) DrainegeStmcturaslndlcaitegSIze&Locaflon?Thls ~N~. I~J~i Item shall include ell Proposed C-rode Chenges end /~MtI0 Ir v'T%tV'~(DP ~'~O1~)} O,opes Controlling Surface Water FIow. Uc?~[.\ (10~__ 3 Doas the Site Plan and/or Survey describe the erceiou / and sediment control practices that will be used to r ~ ' · ' control site erosion and storm water discha~Jsa. This . item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Lend Filling. Grading or Excavaiton where thera Is a cberlge to the Natural r~ Fxisfing Grade In¥olvlng more limn 200 Cubic Yards of Material within any Hercel? 5 Will this ApPlicaiton Require Lend Disturbing Actlvitles £ncompassin~ an Ama in E×cese o[ Five Thousand (5,000 $.F0 Square ~oot of Oraund Surface? Site? Is this Hrolect within tho Tmstaes ]urisdictiou G~l~ral DEC 8WPPP Requlmmenth: or within One Hundred (100') feet of a Wetland or Submissinn of a SWPPP is required fo* ell Constmstion astivilles involving soil Beach? dt~urbances of erie (t) or more ac*es; including disturbances of less than one acre that 7Will there be Site preparation on Existing Grade'Slopes am pea of a laqler common plen thth wil ultlma~y distur'o one or more acres of lend; which Exceed Fifteen (t5) feat of Veritcal Rise to r~~ including Co~tn~on aofMIles invclving ~ol disturt>ances of le~s than o~ 0 } acre vth~re One Hundred {~ g0'l of Hedzo~ltal Distance* the DEC has determined that ~ 8PD~$ permit is required for storm water dlscharg*~. ' requ!red, post-co~tmctkm ~thm~ water manag~rnent practices that wl~ be used *nd/or Removal of Vegetation end/or th* Conslmciton of eny r'~ coubrrY OF ....: ............ ~ .................... SS t ~' '"""~'[~'~'~;/,i';/~hl;~'~6' ................... betng duly ~wom, deposes and says that he/she ~ the applicant for Pemut, Andtha~h shc~sthe ~ t~ D e/ ' .............. :: ........... Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and fde this application; that all statemenra 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 herewith. Sworn to be[ore me this; ............................ · ~....r--~-..... day.of ...................................... ¥11?,KI ~ ~ · - ~. ~ Notapj Public State of New Ye ............................... .. uualifie0 in Suffolk C0unt~ (s~,,st~ of Applicant) / .......................... hdv. R .qB ~ _3 FORM - 06/t 0 54375 Main Road P.O. Box 1179 Souii~old, NY 11971.0959 Telephone (631) 76.%1802 BUILDING DEPARTMENT TOWN OF $OUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: License No.: ~,ddress: Phone No.: JOBSlTE INFORMATION: *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax Map District: 1000 Section: (*Indicates required information) Block: Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) (Please Circle All That Apply) *Is. job ready for inspection: ~'Do you need a Temp Certificate: Temp'lnformation (If needed} · · Service Size: 1 Phase · New Service: Re-connect Additional InfOrmation: 3Phase (~NO Rough In Final YES / ~ 100 150 200 300 350 400 Other Underground Number of Metem Change of Service Overhead , PAYMENT DUE WITH APPLICATI N~~'~~Dtg-~ ~I--~ 82,Request for Inspection Form BUILDING PERMIT EXAMINER CHECKLIST Applicant: Architect/Engineer: scm# ooo- / / ? Suhdivisi0n: Property Address: *Date Submitted: 6 ~)-/'~ 0 Date Reviewed: 7'-/--/0 y Ow.er:/¢/cf/4 z. Estimated Cost: e-- Zone: Conforming? /O~--~":v A// (2 Pre COs? Building Permits (Open/Expired): Bi' __-Z / C/0 z-__, Info: BP -Z / C/0 Z- , Info: BP__-Z / C/0 Z- , Info: BP 8Ingle & Separate Search Required? Y o~Deiermination: REQ. Lot Size: ACT. Lot Size: REQ. Front ACT. Front REQ Side ACT. Side REQ. Height. ACT. Height Projec~tio~.~, ~ Waterfront? Y or(,~.9 ~ ~ .A/~/ ~ If yes, water body: Panel# Flood Zone: __ BP__-Z / C/O Z- , Info: __-Z / C/0 Z- , Info: _ REQ. Lot Coy. __ REQ. Rear__ ACT: Lot Coy. PROP. Rear Bulkhead/Bluff Distance: ADDITIONAL APPROVALS REQUIRED Suffolk County Health: YoO If yes, ~Bed#: *Date: / / _**Perm. it#: - If no, certification requiredi Y °~Recelved: Y or N By: NYS DEC: Pa~-vECgmTS Y or~- Date: / / Permit #: Southold Trustees: y oq~- Date: / __ Southold ZBA: Y or~- Date: / /__ Southold Planning: Y Or~- Date: /__ Town Landmark C of A: Y or~)DTE: __ __ Permit #: Permit #: Permit #: / l~otes: Town Septic: Y or lq or NJ Letter - Notes: or NJ Letter -Notes: - Notes: - Notes: *NYS CODE Compliance (page 2): Y or N Fee Structure: Calculation: Foundation: SF 1. ( SF)- ( First Floor: ' SF Second Floor: SF Other: SF 2. ( SF)- ( Total: SF .SF)= SF X $ =$ + Initial Fee: $ + Additional Fee ( ): $ .SF)= SF X $ __ =$ + Initial Fee: $ + Additional Fee ( ): $ TOTAL: $ oT,.~-O, o O SUP'CE'r' OF: LOT 4 "I'4AP OF: PEGONIC HOI'dES" SI'I-UA-FIE, PIECX2NIC, TOI~IN, ~::~blTt~L~ .SUF--t=OLK C, OuN'rT', NY JOHN C. 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Always obey and enforce all safety rules to avoid injury. There are many choices in today's above-ground pool market. Lomart pools are among the best in the industry and we would like to prove it to you. Read over our facts and Dare to Compare us with our competitors! We are confident you'll agree -- Lomarr, is your best choice for above-ground swimming pools. [~a~i~r I~oo] 1~l~. Fact: Lomart Walls are made from heavier Copper Bearing Steel than industry standards -- 30 to 60 pounds heavier for superior strength. ~llrP, ¥¢F[i~ft] ~l'l~pOld,,~ Fact: Lomart Pools have as many as 20% more vertical supports than other brands to ensure stability during heavy family use or the coldest of winters. ~]~e (]~ ~opDo['t~. Fact: Lomart Oval Supports extend only 9 inches beyond the sidewall, not the standard 36 inches. This allows a Lomart 18-foot wide pool to be installed in the same space as another brand's 15-foot wide pool lJ)]'[~[~iO]~ Pr~]l~ ~[~]]~. 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Using a special skimmer U-gasket and advanced wall coatings, Lomart. eliminates the dangerous effect of "Dissimilar Metal Corrosion" which is caused by incorporating stainless steel panels with galvanized steel pool walls. Over time this will cause the wall at the two connection points to rust away and lead to pool failure. Our designs ensure structural integrity and beauty throughout the Lomart pool line. Changa of Oesign: All size~, weights, measu~ments, illustrations and other specification~ are approximate. Lomart Industries expressly rese~es the right to change or modify the design and construction of any pmduot in due course of our manufacturing procedu~s without incurring ~ny obligation or liability to furnish or install ~uch change~ or modlf~catlons on p~duc~s p~ious~y or subsequently sold, Loma~ industries is in no way a~liated with any professiona~ pool installec Therefore. Lomart can a~ume no responsibility for er~rs in in~t~llation by the homeowner or ~a~ professional inotalle~ If you ha~ th~ p~ol in~t~l~ed by otaer~, please ~upe~i~ to be sure they comply with proper installation techniques as shown. Lomart InduetHes · 227 Route 33 · Manalapan, NJ 07726 · (732)786-1990 Visit our website at www. lomart.com 1104-004 1-2000-017 Colmdright © 2005 TOW O?S UX OLD BUILDING DEPARTMEI'q TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502~ SoutholdTown.NorthFork Examined Approved t7 '"" { JJUN 2 1 ~0 BLDG. DEPT, _,20/0 COMPLY VVr'TH ALL CODES OF ~W YORK STATE & TOWN CODES BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Planning Board approval ~ Survey .--- N.Y.STITE.C. Trustees Flood Permit Storm-Water Assessment Form ,20 [¢S REQUIRED ~ C,~°ntact: Mail to: UNDERWRITERS CERTIFICATE REOUIRED OARD )ector "IMMEDIATELY" ENCLOSE POOL TO CODE UPON ~PLETION APPLICATION FOR BUILDING PERMIT BEFORE 'WATER" OCCUPANCY OE USE IS UNLAWF(}; - WITHOUT ' 07 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises /~;(..~,.~ I .-~ .~tl~---~ /-']~[fVxa y (As on the tax roll or If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed' work will be done: House Number ' ' Str~e]~~ FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING, PLUMBING, STRAPPING, ELECTRICAL & CAULKING 3. INSULATION 4 FINAL - CONSTRUCTION & ELECTRICAL MUST BE COMPLETE FOR C.O. ALL CONSTRUC~Ofl SHAU. MEET THE REQUIREMENTS OF THE CODES OF NEW p , YORK STATE. NOT RESPONSIOI..E FOR _IL~.~.j::~D_E~ESIGN OR CONSTRUCTION ERRORS. Hamlet County Tax Map No. I000 Section Subdivision Filed Map No. Lot