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Home My WebLink About35969-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 4/18/2012 CERTIFICATE OF OCCUPANCY No: 35550 Date: 4/18/2012 Location of Property: SCTM #: 473889 Subdivision: THIS CERTIFIES that the building IN GROUND POOL 1405 ACKERLY PD LA SOUTHOLD, Sec/Block/Lot: 69.-5-7.2 Filed Map No. conforms substantially to the Application for Building Permit heretofore 10/15/2010 pursuant to which Building Permit No. Lot No. filed in this officed dated 35969 dated 10/25/2010 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 in ground swimming pool with fence to code as applied for. The certificate is issued to EDWIN & NANCY B WARD (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 35969 5/2/11 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILnING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35969 Z Date OCTOBER 25, 2010 Permission is hereby granted to: EDWIN & NANCY B WARD 1405 ACKERLY POND LANE SOUTHOLD,NY 11971 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL AS APPLIED FOR, FENCED TO CODE at premises located at 1405 County Tax Map No. 473889 Section 069 pursuant to application dated OCTOBER Building Inspector to exlDire on APRIL ACKERLY PD LA SOUTH/PEC Block 0005 Lot No. 007.002 15, 2010 and approved by the 25, 2012. Fee $ 250.00 Authorized Signature ORIGINAL Rev. 5/8/02 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: 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 cot/sent 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 $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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. I O'~ok~-'l 0 New Construction: Old or Pre-existing Building: Locationoferoperty: /c[O~- /tgi ~ ~'Xd~ House No. Street Owner or Owners of Property: ~k,,~ gQ Suffolk County Tax Map No 1000, Section ~a~ Subdivision Permit No. 3-Dc~ ~q Date of Permit. Health Dept. Approval: Block ~'"~' Filed Map. Applicant: Underwriters Approval: (check one) Hamlet Lot '~t ~ Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~--~. ~ '~ ,~'~ , 0 (.~ Final Certificate: (check one) Applicant Signature 'From I lall Aniwx .5 tl7,5 Main Road P.(). Box 1179 SoulhoM, N'I' 11971-0!t,59 Telephone (631) 7ti.3-180~ l:;cx (631) 76.5-9,5t)2 ro.qer, dchert~..town.so uthold, ny. us BI 'ILl)lNG I)I'1'AI'ITMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: E & N Ward Address: 1405 Ackerly Pond La City: Southold St: NY Zip: 11971 Building Permit #: 35969 Section: 69 Block: 5 Lot: 7.2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Peconic Electric LicenseNo: 43457-rna SITE DETAILS office Use Only Residential ~ Indoor ~ Basement ~ Service Only [~ Commedcel Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Su~ey Attic Garage INVENTORY Service 3 ph Hot Water GFCI Recpt Main Panel NC Condenser Single Recpt Sub Panel A/C Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling Fixtures ~ HID Fixtures Wall Fixtures I I Smoke Detectors Recessed Fixtures~ CO Detectors Fluorescent Fixture ~.~ Pumps Emergency Fixtures~_~ Time Clocks Exit Fixtures [~ TVSS swimmin9 pool to include, bondin9, 2-lights, 3-GFCI circuit breakers, elec pool he~ Inspector Signature: Date: May 2 2011 81-Cart Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [/~FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ]INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION DATE / ~ / INSPECTOR '~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING / STRAPPING [ ] FINAL FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [~LECTRICAL (FINAL) REMARKS: DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG, [ ]FOUNDATION 2ND [ ]II~LATION [ ] FRAMING/STRAPPING [,~/]~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: ~~-~ / DATE INSPECTOR TOWN OF SOUTHOLD BUILDIN(~ DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 Examined [O/) ~ 0 /O Approved /d/~'~, 20 /O Disapproved a/c~ /0//~//:~_'~ ._.~ 7,/ ' / PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying ? Board of Health 3 sets of Building Plans Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: a. This OCT 15 BLDG. DEPT. TO.WN OF $OUTHOLD Building Inspector kTION FOR BUILDING PERMIT Date INSTRUCTIONS tiled 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 prem/ses, 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 a Certificate of Occupancy is issued 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 al~licable laws, ordinances, building code, housing code, ah regulations, and to admit authorized inspectors on premises and in building for necessary inspections. / / a / / E2 E?I ToECLOY;', USE IS UNLAWFUL (Signature o ap cCf i, a corporation) OF OCCUPANCY (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, g~ncral contractor, electrician, plumber or builder Name of owner of premises If applicant is a corporation, signature of duly authorized officer t~qame and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. APPROVED AS NOTED (as on the tax roll or AT NO,FY 8UI~ ~NT~ 7654802'~ 8 ~ TO 4 ~F~ ~ FO~LO~NG I~PECTIONS: 1, F~UN~TI~, T~ REQUIRED 13.INS~NST~PING' E~CTRI~ & CAULK~G a. FINAL- CONSTRUCTION & ELECTRICAL RE~IRE~NT8 ~ ~E C~8 OF NEW Y~ ~A~, ~T ~ ~ 1. Location of land on which pro~sed work will be done: House Nmber ~eet County Tax Map No. 1000 Section Subdivision ¢4ame) Map ~0. ~t ~STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE. 2. State existing use and occupancy of premises and inten~led use and occupancy of proposed .construction: a. Existing use and occupancy b. Intended useandoccupancy ~P~/)t~ ~ItV//tlM.~ ~ 3. Nature of work (check which applicable): New Building RePair Removal Demolition Eshmatea Cost ]J-~{~I~Q- Fee Addition Alteration OtherWork T'~qz2,~Cd,~t ~m~/~,,~ · F (Description) If dwelling, number of dwelling units If garage, number of cars (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 6,0' Height Number of Stories Rear DePth Dimensions of same structure with alterations or additions: Front Rear Depth. Height. 8. Dimensions of entire new construction: Front .2~ ~ Height Number of Stories 9. Size of lot: Front 2~0' Rear ~,6/~ Number of Stories Re~ Dcpfh ~[z. ~8 ' DePth I0. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated ' 12. Does proposed construction violaie any zoning law, ordinance or regulation: 13. Will lotbere-graded ~3C .~.0./( ~.l~ Will excessfillberemovedfrompremises:(Y~ NO 14. Names of Owner of P~e~ises~Address)~ P~t~ ~10DdPhone No. Name of Architect ~,~}~ ~ .[5 Address 4~_~1J,~ ~)~mm~ Phone No Name of Contracto~m~ot ~o~ ~ou.~, Address q2-a/ igrzr' ~dtt,~ Pc PhoneNo. 15. Is this property within 100 feet of a tidal wetland? *YES NO ~ ~ . · IF YES, SOUTHOLD TOWN TRUSTEES PERMt~-MAy BE REQU~ 16. Provide survey, to scale, with accurate foundation plan and di~ances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) ....... ?'qUTIO~, ~-zur,,,~Cl$ ' being duly sworn, deposes and says that (s)he is the applicant (Name of individuak~t~g_~g c.o~n!r~ac.t) above named, (S)He is th~5 -. ...... (Contract6r, A~ent, Corporate Officer, etc.) of said owner or o~..,r~;*aii~ ig ' .~.B04%~.', riZea to perform or have performed the said work and to make and file this application; that all stat?.m, ,,e~.ts ~ontained in this a~p[~ati°n are tree to the best of his knowledge and belief; and that the work will be p orme'~ ill/t~ m~tr~Sr set ~6¢thanlhe _a~np.~hcatton filed therew2h Sworn . MARGARET A. KIDNEY NoWy Pul~c -Stme o~New Yod; No. o I KI6021111 ~i'gnature o0pplicant Town of Southold' ~ Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM u~/O~~ PROPERTY LOCATION: S.C.T.~ ~: THE FOLLO~NG A~IO~ MAY REQUIRE THE SUBMI~ION OF A n ~ ~* ~ STOR~WATER~ G~DING; D~INAGE AND EROSION CO~ROL P~ Dis~lct S Bilk ~ CERTIFIED BY A DESIGN PROFE~IONAL IN THE STATE OF N~ YO~ SCOPEOFWO~ - PROPOS~ CON~U~ON ~ / WO~S~S~ [ -Y~ No a. Whati~eTo~l~aof~ePmje~Pa~b? 1 ~ll~lsProje~Re~in~lSto~Wat~Ru~ (IndUe Total Ar~ of all Par~ ~t~ ~in J ~O / Genemt~ by a ~ (2") In~ ~in~ll ~ S~e? · e S~ of Wo~ for ~ ~n) b. What ~ ~e To~l ~a of ~nd Cl~dng (s~.~ ~) ~is ~em ~lHn~ude all m~ff ~ by ~ dea~ng a~ ~s~on ~es as ~ll ~ all an~or Ground D~tu~an~ f~ ~e ~ed ~ ~O ~ * Site Impmvemen~ and ~e pe~anent ~afl~ of c~s~n a~vi~ Im~s su~,) (S,F.~) 2 D~S ~e Site Plan an~or Su~y Show NI Pm~ PRO~E B~ PRO~ D~ON ~ ~. ~ Drainage ~res Indicting Size & L~on? Item ~all include all Prop~ed Grade ~anges a~ 0~ 2¢'~ ~1 '~ L Sl~O Slopes Con~,ling Sudaco Water Flow. I 3 D~s ~e Site P~an and/or Su~ey d~ ~e e~ion ~ s~ e~n and st~ ~ter di~a~. ~ls item m~ be maln~in~ ~mughout ~e Cons~on Ped~. 4 ~ll ~is Pmj~ Require any La~ Fitling, Gmdi~ or ~on ~ere ~ere is a change to ~e NaOmi E~sfi~ Grade In.lying more ~an 200 Cubic Ya~s of Matedal ~thin any Parcel? 5 Will this ~pli~tion Require Land DisPuting A~vi~es En~mpa~i~ an ~ea in ~cess of Five ~ousand (5,~0 S.F.) ~uare Feet of Ground Sudan? 6 Is ~ere a Natural Water Coume Running ~rough ~e Site? Is ~is Pmje~ ~thin ~e Tm~ees ju~ General DEC S~PP Requlm~n~: or wi~in One Hundred (100') feet of a Wetland or d~an~ ~ ~ (!) or ~m ~; ~cl~ dl~s of ~ ~an ~ ~ ~at 7 ~11 ~ere be SRe preparation on Exi~ng G~e Slopes am pa~ of a la.er ~mm~ ~n ~at w~l u~ d~ o~ or ~ a~ of ~nd; whi~ Ex.ed Fifteen (15) feet of Ve~l ~seto In~i~ ~n a~ Inv~ ~ db~n~ of ~ ~a~ ~e (1) ~e ~ One Hundred (100') of Hodzon~l Dista~? 2. ~ S~ ~ ~ ~ ~ a~ ~d~t ~ ~ ~ ~ 9 ~11 ~is Proje~ Require ~e Pla~ment of Mat~al. ~uimd. ~l~ s~ ~ ~e~nt ~ ~at ~ ~ ~ and~ Rem0~l of Vege~fl~ and/or ~e ~ns~ of any ~ ~ ~ ~ ~n~ ~ s~ ~ d~e~ a~ ~ ~m Item ~ln ~ T~ ~ght~f-Way or R~d Sho01d~ q~at I, ~ 3 ~0~ ~g d~y sworn de scs ~ ~or ~pr~en~five of ~e ~er or ~, ~d is d~y au~o~d to ~ffo~ or have ~ffonned ~e ~d work ~d m~e ~d ~e ~s applic~on; ~t ~1 sm~m~m con~ed ~ ~s apphca6on ~e ~e to ~e best offs ~owle~e ~d be~ef; ~d · at ~e ~rk ~1 ~ ~o~ed in ~e ruer set fo~ ~ ~e apphmfion flied herc~. Sworn to before ~e ~s; · ...................... ............ ....................... /7 / FORM - 06110 No. 01KI6021111 Tow~ Hall Armcx 54375 M~u Road P.O. Bo~ 1179 Sou~old, NY 11971-095~ Telephone (631) 765-1802 BUr/.r~ING DEPARTMENT TOWN OF 80UT~OLt3 APPLICATION FOR ELECTRICAL INSPECTION Company Name: Name: Date: License No.: Address.: Phone No.: JOBSITE INFOF; *Name: *Address: · *Cross Street: *Phone No.: Permit No.: Tax Map District: 1000 Section: . ~)dJ Block: ~ Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) ~0/~ I~/0,t~?'_'~ (Please Circle NI That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: YES I NO Rough In Final YES / NO Temp'lnformation (If needed} · · Sen/ica Size: 1 Phase 3Phase 100 150 200 300 350 400 Other · New Service: Re-connect Underground Number of Metem Change of Service Overhead Additional InfOrmation: PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form Town Hall Annex 54375 Main Road P.O. Box 1179 Soutbold, NY 11971-0959 Telephone (631) 765-1802 . . _Fax (631) 765,-.95Q2 roqer.ricnen(o3,town.soutnola.ny.us BUILDING DEPARTMENT TOWN OF SOUTHO~ APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: '~-~((Cb~ ~--J~l Eb~'~f~ . Date: Name: //~'O,c.~/~ [~-~_~-~'7-,d/~ Company _icense No.: ,O~ ~( 7 - ~ Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: ,,~-~ <~ 'Address: / Z/O~ *Cross Street: / *Phone No.: Permit No.: Tax Map District: 1000 Section:~ ~ ~) 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: YES ~ Rough In Final Temp Information (If needed] *Service Size: I Phase *New Service: Re-connect Additional Information: 3Phase 100 150 200 300 350 400 Other Underground Number of Meters Change of Service Overhead PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form Suffolk CounOz Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 7/1/78 No. 4436-H SUFFOLK COUNTY _I-~on~ e .hn?ro veJn en t Con tractor License This is to certify that ARTHUR J EDWARDS doing business as ............ ART_.H. UR_EDWA_RDS. ~M~_ SON..CO~T__P,~_. CTING [NC having furnish.ed the requh'emem::; sec forth in accordance with and subject to the provisions of applicable laws, talcs and regu2ations ofkhc Counvy of Suffo~, State of New York is hereby licensed to conduct business as a ..HOME ~IMPROVI~_MENT CONTRACTOR, in the County of Suffolk. Ai:lditional Businesse~ Dix~2tor Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 5/1/80 SUFFOLK COUNTY Master Electrician License No. 2740-ME This is to certify that EDWARD S REIFF doing business as UNDERGROUND SPECIALTIES INC having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of' applicable laws, rules and regulations of the County of Suffolk, State of New York. bearer ia ~luly Ilee~ed by the Ceen~y of MASTER ELECTRICIAN EDWARD $ REIFF 2740-ME 111980 ~xm~ ~ 05/01/20f 2 Additional Businesses Directol Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631 ) 765-9502 April 17, 2012 BUILDING DEPARTMENT TOWN OF SOUTHOLD Edwin & Nancy Ward 1405 Ackerly Pond Rd Southold NY 11971 TO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: J Application for Certificate of Occupancy. (Enclosed) - Just needs your signature, has been paid already. __ Electrical Underwriters Certificate. (contact your electrician) __ A fee of $50.00. __ Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 4/1184) Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. BUILDING PERMIT: 35969 - Swimming Pool A-C B-C A-D B-D A-E B-E A-F B-F A-H B-H A-J B-K A-M A-N B-N B-P A-R N-P 19'-8" 19'-6" 9'-2" 24' 34'-3" 30' 24'-11" 26'-11" 36'-3" 29'-7" 29'-4" 39' 28' 59' 59'-11" 32'-3" 50' 50' 62'-11" 52'-8" 52'-8" 26'-8" 26'-8" B $ S 24' 14' H G 9'-2 1/2" R R IPERIMETER= 194 IYDS.CONC.= 21 IREBAR= 29 [FORM TIES= 240 M · N ' P2'~2 I~lur EcIw~]rds Pooh 2 Ii I-- B D Plan Section B-B Section A-A A O Typical Piping Arrangement Wall Section SI~ A B C D E F G H AREACAP. FgET FI. FI. FI, FT. PI. FT. FI. Pr, Bq~vr. CAL. 18x~2' 16' 32' 8' 14' 6' 4' 4' 8' 512 19,000 18'x36' 16' ~' 12' 14' 6' 4' 4' 8' 576 21,600 18'~' 18' :{6' 12' 1~' $' 4' 5' 8' 648 20'x40' 20' 40' 18' 14' 6' 4' 6' 8' 800 24'x44' ~4' 44' 18' 14' $' 4' 6' 10' 79~ ~0,000 24'x48' 24' 48' ~0' 16' 8' 4' 6' 10' 9~0 ~0,00( PERMACRETE WATJ. SYSTEM 929 Route 25A Miller Place NY 11764 (631) 744-7185 FAX (631) 744-0t74 Suffolk License #4436-I-H Nassau License ~HI74450000 SUCFOLK COL~TY DEPARTMENT (N~ HEALTH ~r. RVICES FOR APPROVAL OF CONSTRUCTION ONLY RI 0-94-0081 DATE H~ FIEF. NO. 'APPROVED I am familiar wi/it the STANDARDS FOR APPROVAL AND CONSTRUCTION 0~' SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMtLY RESIDENCES and wilt abide by /he conditions se/ forth titereJn and on lite perm// Io construct. ED WARD TOWN. ~ SOU~O~ N ~- ~ - ~ P/O o7 Oct. I~ 1995 AREA = 25386 Acres LIC. NO. 49618 ~£v~noNs ~ ~ TO ~V~ % shown hereoa ore /r~ SOUTHOLD~ N.Y. 11971 ~ 94-201