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Home My WebLink About40640-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board ofHealth SOUTHOLD,NY 11971 4 sets of Building Plans TEL:(631)765-1802 Planning Board approval FAX: (631)765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. _ Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined 20 b Storm-WaterAssessment Form Contact: Approredl •_f} V Disapproved a/c Ex iratio20 D _ 4Lu,, , r All APPLICATION FOR BUILDING PERMIT Date l i.........._ — 20_1 b INSTRUCTIONS 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 authorized has not commenced within 12 months after the date of issuance or has not been completed within IS 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 premises and in building for necessary inspections. " -70' ! ............. (Signature ofapplicantorname,ita :orporati n) (Mailing address of applicant) 11-7&3' State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises t T lr t .._----- .... ..... (As on the tax roll or latest deed) If applicant is a corporation +g tux4--tl4l-y- uthorized officer Name and title of corporate rp ate officer) Builders License No. c;L'7 ........................ Plumbers License No. Electricians License No. `-f O,SS- -7 A-t C- Other Trade's License No.. 1. Location of land on which proposed work will be done: lyer,-fits .......� .. `acs 7 e}�...... ......... House Number Street Hamlet County Tax Map No. 1000 Section Block Lot Subdivision _� v, . _/.�� Filed Map 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and 3. Nature of work(check which applicable):New Building......... Addition Alteration RepairRemoval Demolition Other Work _g c- (Description) 4. Estimated Cost --, 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 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 Rear 6-41,, ',��'�';!,,",,r 7�*;D"61)tb� Height Number of Stories Dimensions of same structure with alterations or additions: Front woe Z-t--�,ROa 11 Depth Height Number of StoriT" — " 8. Dimensions of entire new construction:Front- Reary— T Height Number of Stories 9. Size of lot:Front—LC � 1,� Rear 39 �3. 10.Date of Purchase <)--O Name of Former Owner s"k" flie's I 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 Will excess fill be removed from premises?YES—NO 14.Names of Owner of premises A ct Re,rjLjhAddress c,o.y��qLtPhonc No.63E-' .:2...-aY 0/ Name of Architect Address ........m,—Phone Name of Contractor 5P�r�,,L u lc-- Poo K,,t.Phone No. I-6 9 G 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO. *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. 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) SS: COUNTY OF -D sworn,duly swo ,deposes and says that(s)he is the applicant , <-A� (Name of andi vidWit signing contract)above 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. DAWN DWYER Sworn to before me this Notary Public,State of NewYork Sr day of April 20 C)ualft-"OW6282704 Qualified in Suffolk County Qualified C"'J"IV,E�xpulnss May 28 a May 28,�201 Nota�y)Public Signature of Applicant UT Scott A. Russell U 0. ,w„�r...._, SUPERVISOR MANA SO OLD TOWN HALL-P.O.Box 1179Town of Southold 53095 Main Road-SOU OLD,NEW YORK 11971 ab >� CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOL F ANY OF THE Ie OUO ISG: (CHECK ALL THAT APPLY) Yes No Clearing, grubbing, grading or stripping land which affects more than 5,000 square feet of groundsurface. E][31S. Excavationor f illing involving more than 200 cubic yards of material within any parcel or any contiguous area. ,. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion azar area. Site aration within te one-hundred-year floodplai s depicted 0 n FIRM- Map-oI an watercourse-m__ _ --- F. Installation of _ ° - y - f new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. i at a Contact Information, Date & County Tax STOP! Complete _. , If you answered N to all of a questions above, Com Tete a Applicant section below your Name p p 1236 does not apply to your project. If you answered S to one or more please Number! Chapter copies the above, lease submit f a Stormwater Management Control Plan and a completed Check List Form to the Building Department with -your Building Permit Application. APPk.YCA. - t � ......� S.C.T.M. B1000 Date" (Property roP r, 7eesr®rro ESICra 51ontractor,otkwrl nc —s 10 §e'_ W Contact Wormation r Reviewed By: Date: _.. _ ...__ _ ........ _ _ _ . .. ..... ..... �-s l Location of or�st(-uctkokt Work: ..�, . Pro ert A.ddre.� " A�proved for processing... _ � t.. ................. 0 Strn�water Management Control Phan °o t Required. d.. .. ._, ", a _ .. Storrnwater Management Control Plan. is Required. . . 1 �.-�......_ El (Forward to Engineering Department for R.eview.) FORM 4 ,SMCP -TOS MAY 2014 SPECCA OP ID:VM DATE(MMroorrm) CERTIFICATE OF LIABILITY INSURANCE 0312212016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELQ�V. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING I SU ( } AUTHORIZED REPRESENTIMPORTANT: If theVE O fiODUCER,AND THE CERTIFICATE HOLDER. certificate holder an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the Inc. r=�o� Ex 631 -1111. . certificate holder In lieu of such en orsemen s Bagatta Associates, ncI Bagatta Associates,Inc,�w.... FAX Arc, I 637 274 PRODUCER NAmr=: 823W Jericho Turnpike Ste 1 --It -- Smithto , NY11787 ADLIIS: Bagatta Associates,Inc. _ 2E011 c ..� INSU SUs)AFFORDING Ce OmC a,n INSURERA: esCo In ran OVERAGE _ . FFO .. .._ INSURED ,S peoht-Taoular Pools, Inc. 3661 Horselock Road,Unit R INsaaRa c. Medford, NY 11763 INSURER CN ..._ ,_.... � ..._.i .., INSURER E x ._ INSU.RERF: CATE COVERAGES IS TO CERTIF`YTHAT THE POLICIES ES OFI INSURANCE BELOW HAVE BEEN ISSUED TO THE INSUREDNAMED NUMBER. ED ABOVE FOR THE POLICY PERIOD HIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE INSD LIMITS SHOWN NUMBS - LI L XP _ PO.......N IN 8 R � �iMiD MM9DDfYl"Y'Y MRs LT�EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, _ A X COMMERCIAL GENERAL L,IA13 LITY EACH O LU rET,E. 00,000 �rI - 100,000 CI..AIMSMADE' crr.,CIJR PP119817401 09118!2015 09118120116,Ffehrel'SESSCEaw�dcrcrmnccl t 10 9 L..... 5,000 IVIEi7 f=�J'IAeb"aru�aa Ga°ear,) S 1,0'00„000 PERS NAL ADV INJURY 2 I'00 000 _... A �GF,1'1-AGGREGATE LIMIT APPLIES PER: GENERAL AGGPEGA{"I POI.-Icy El��r ❑Loc _ 2,000,000 pl("r- PlRoDucrs-COMPIOI ACG $ OTHER Os�91E+IN�"Cw SIN !L LIP�tT AUTOMOBILE LIABILITY Ea ac BODILY INJURY(P Person) � ANY AUTO AUTOS NUSAUTOWNED Y INJURY(Per accic9enYy "�' ALL..C)W IED SCHEDULED BODILY T .__ PROPERTY DAMAGE I-41RF_D AUTCYS AUTOS Per UMBRELLA OCCUR OCC,JRR NC;E 9 EXCESS LAB CI._AIIAS-MADE AGGREGATE a DED ENi ION$ AUT H- NYOR@CERS OMPI:INSA"P101hl SIAfUlL= 1ElR A EMPLOYE 'LIABILI'r mm N T Y r N E I_ E.AC H 61C CIDFNT ANY PROPRIF_ORIPARTNERI CU I IVE N I A OPPIC ERIMEMBER EXCLUDED? E I_ DISEASE. EA FP+PLOYEE s (MairbdatoiiY in INH) If yes describe under E.L (DISEASE-POLICY LIMIT $ DESC„RIP PION OI=OPFRA"IIONS below A Property Section PP119817401 09/18/2015 09/18/2016 BPP 20,00( Lied, 1,00( DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Swimming Poral Installation,Service and Repair. As pertains to insured's operations,the Tonin of Southold, Building Dept., Main Street„Town Mall,Southold,NY 11971 is lusted as additional insured as perwritten contract,subject to the terms and Conditions of the policy. CERTIFICATE FOLDER CANCELLATION UTH0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH E POLICY PROVISIONS. TOWN OF SOUTHOLD BUILDING DEPT AUTHORIZED REPRESENTATIVE AIN STREET,TOWN HALL —. . UTHL ,NY 11971 -- C°31 -2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i ,L V 6 l �' t@ BeCs special I Workers`t Baa p ' RPO D' y ° Since 1 y14 8e•CORPORATE CENTER D R 7� 300 LE`NEW YORK 11747-3129 Phone:(63 CERTIFICATE OF KERS' COMPENSATION INSU E AAAAAA 01 957 SPECHT TACULAR POOLS INC 3681 HORSEBLOCK RD UNIT R MEDFORD NY 11763 i CERTIFICATE HOLDER POLICYHOLDER TOWN OF SOUTHOLD SPECHT=TACULAR POOLS INC BUTLDINO DEPARTMENT 5561 HORSESLOCK RD UNIT R MAIN ST'REE'T'",TOWN HALL MEDFORD NY 11'763 SOUTHOLD ?DIY 11971 DATE POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE 79012 gl1PL015 9 612015 TO 09/2612016 12163665-9 0912 EW YORK STATE INSURANCE ER THIS IS TO CERTIFY THAT THE'POLICY UNTIL O NAMED1 COVERINGNSURED VVITH THE ENTIRE OBLIGATION THIS RESPECT TO ALL , FUND UNDER POLICY NC.2163 565 9 LINTIL E NEW FOR WORKERS' COMPENSATION UNDER THE NEuN YORK 'WORKERS' COMPENSATWITH ION LAW SP IN T HT=STAB OF NEW YORK EXCEPT IN� NEW YORK STATE �I CYEES ONLY. OPERATIONS Tt'OItiVS, OPERA71ONS THE STA TO THE POLICYHOLDERS REGULAR OUTSIDE OF" N V IF SAID POLICY IS CANCELLED,CIR CHANGED EI CANCELLATION, MILL IN GIVEN TO THE TO THIS PROVISION.AFFECT LR 'gid . 1'0 DAYS WRITTEN NOTICE OF SUCH, NOTTOE BY REGULAR L SO ADDRESSED SMALL BE SUFFICIENT COI�IPLIANCP YORK S'T"A"T'E INSURANCE FUND.... GOES NOT ASSUME ANY LIABILI'T'Y IN THE Er1ET�IT OF FAILURE TO C°=&V"�` SUCH NOTICE i THIS POLICY DOES NOT COVER CLAIMS OR SUM THAT ANISE FROM BODILY IN,TURY SUFFERED BY THE OFFICERS OF THE f INSURED CORPO'RATIDETERSPECHT,PRT=S OF'SpECHT-TACULAR POOLS INC ('ONE PERSON CORP) i THIS CERTIFICATE IS ISSUED ASA MATTER OF I bFCI TION ONLY AND CONFERS NO RIGHTS NOIR INSURANCE OO'�IERAGTc UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTS' THECOVERAGE AFFORDED By THE POLICY' ,I it NEW YORK STATE INSURANCE FUND q=t We— La DIRE,CTOR,INSU CE FUND UNDERWRITING i I6 0 be+� IR .I ��our web site at h :Il .nysif.�mlcertl 1.ssP Or by calling( I�6)T375�"T9 This VALIDATION NUMBER 9 69778 U-26 3 ,3/11/?-012 14:42 5165046400 5165046400 Additional Instructions for Form DB-1 20.1 By signing this form,the insurance:carrier Identified In Box"3"on this form is certifying that it is insuring the business referenced in lox"i a'for disability benefftsunder the New York State DisabditY Benefits Law.The insurance carrier or Its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder to Box'2".This certificate is valid fGEAba-eRtliff-Of one year after this fbrm is approved by the insurance caiTler or its licensed agent,or the policy expiration date listed in Box*W. piesse Note:upon the canceiiation of thedisabi I ity renerts pati r indicated on this form,if the biasi"Mccntnuester be named an a permuL license or contracLissued by a certificate holder,the business must provide that certificate liolder with a new Certificate of NYS Disability BenefitsCoveragg Or Other authorzed proof that the busjnew iscOmPiYing wth the mandatory coverage requirernents,of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW Section 220. Subd. 8 (a)The head of state or municipal department,board,commission or office authorized or required by law to issue any,permitfor or in connection with any work involving the employment of employees in employment as defined in this article,and notwithstanding any general or special statute requiring,or authorizing the Issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits for all,employees has been secured as provided by this article, Nothing herein,however,shall be construed as creating any liability on the part of such state or municipal department,board,, Commission or office to pay any disability,benefits to:any such employee if so employed. (b)The head of state or municipal department,board,commission,or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in,employment as,defined in this article,and notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits for alb employees has been secured as provided by this article. STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier .......... ........... ................. la.Legal Name and Address of Insured(Use street address only) 1b.Business Telephone Number of Insured SPECHT-TACULAR POOLS INC 631-696-3900 1c.NYS Unemployment Insurance Employer Registration 3661 HORSEBLOCK RD UNIT R Number of Insured MEDFORD, NY 11763 1d.Federal Employer Identification Number of Insured or Social Security Number L010648957 2.Name and Address of the Entity requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity being listed as the Certificate Holder) The First Rehabilitation Life Insurance TOWN OF SOUTHOLD Company of America 3b.Policy Number of Entity listed in box"la": BUILDING DEPARTMENT D152822 MAIN STREET TOWN HALL 3c.Policy effective period: SOUTHOLD, NY 11971 09/26/2015 to 09/26/2016 4.Policy covers: a. LtJ All of the employer's employees eligible under the New York Disability Benefits Law b.LOnly the following class or classes of the employer's employees:] Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed 9/22/2015 By resentativeor Y Li ed Insurance Agent of that insurance carrier) (Signature of insurance carrier's authorized representative or Y Telephone Number 51.6-829-8100 Title Sr. Vice President IMPORTANT:If box"4a"is chocked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If box'4b"is checked,this certificate is NOT COMPLETE for the purposes of Section 220,Subd.8 of the Disability Benefits Law. It must be mailed for completion to the Worker's Compensation Board,DB Plans Acceptance Unit,20 Park Street Albany,NY 12207. .. ......... PART 2.To be completed by NYS Worker's Compensation Board (Only if box "4b" of Pan 1 has been checked) State of New York Worker's Compensation Board According to information maintained by the NYS Worker's Compensation Board,the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Worker's Compensation Board Employee) Telephone Number Title ............ .................... Please Note:Only insurance carriers licensed to write NYS Disability Benefits insurance policies and NYS Licensed Insurance Agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (5-06) Additional Instructions for Form D13-120.1 By signing this form,the insurance carrier identified in Box"3"on this form is certifying that It is jnSUdr1g the business referenced in Box"la"for disability benefits under t'he New York State Disabihty Beneffts Law,The insurance carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in Box"2".This certificate is valid forth earlier of one year after this for is approved by the insurance carrier or its licensed agent,or the policy expiration date listed in Box"W'. Haase Nom UPID11 ihe cancellation od the disability bonehts pobcy indicated on this form,11'the business con unues to be named on a permit,license or,contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disabilily Berlefits Coverage or Qvier authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disablity Benefits Law. DISABILITY BENEFITS LAW section 220. Subd. 8 d or required b (a) The head of state or municipal department, board, commission or office authorize y law to issue any permit for or in connection with any work involving the employment of employees in empioyrnent as defined in this article, and notwithstanding any general or special statute requiring or authorizNng the issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits for all employees has been secured as provided by this article, Nothing herein, however,shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed, (b) The head of state or municipal department., board, commission, or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article,and notwithstanding any general or special statute requiring or authorizing ally such contract,shall not enter into any such contract unless proof duly SUbscr ibed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits for all employees has been secured as provided by this article. DB-120.1 (5-06) Reverse YSEG Long Island 175 E.Old Country Road Hicksville,NY 11801 0rSEGIS] . We make things woik for you. APO 13 2016 April 8, 2016 Mr. Adam Panetta TOWNOFSOUMOID 85 Yennecott Dr. Southold, NY 11971 Notification# 900000027015 Dear Mr. Panetta, On Wednesday, April 6th , I visited your home to take measurements for the proposed installation of your new pool. You may proceed with the installation of the pool as the installation meets our required clearances to our facilities. Any questions, please feel free to contact me at 631-284-5301. S"inc, :ly, s. Rhonda Rim Customer Planning Rep. Distribution Design Riverhead Copy to customer file reference#T_ LOT AREA = 26,318 SQ- FT. 5OR CFO NOWT 6. r.�l ao on Ta. Sno'No u') sow 1 C.O. - @ 22.6 Zv W .qty x dxk ca 44 I° m �' us W O , - 0 1 STY FR DWELL ` ~ POW / caR 3 O o 23.7° 0 pp 89.4. 222" w 20.41( W 3 LS N N N �, N subdivision sign O Z / (YENNECOTT PARK) MBN N 6,V3 1'50"W 193.12' YENNECOTT DRIVE TW t>a>M)CE OF NGW OF tyros AM OR EA S MM OF FECOM F an:NOT%0M ARE NOT MPAWM3. nE arTSM(OR*Mo ons)sxowN Neon FltON THE s�R=WM To INE PROPFmr carts ARE FOR A SPEOM PLXV'=AND USE Nm 71EAE1:T7fE ARE NOT JOB No. 14-12 FILE No. YENNECOTT PARK MEOW m HE F MADE T6MON of FOs.RE0e4Wvus.Pons.POM PLwmjc Awp&Amomom m mmu)p s oR ANY o1Nw commanom SURVEYED FOR ADAM PANETTA waunM=x7MM OR ADDMON To THS SURVEY 6 A A VDAM OF SECRON LOT NUMBER 54 rme of Tw NEM Yow grAE ETON Lm MAP OF YENNECOTT PARK GVPPAKVM Mta TED RM 0wV To THE PetSUM FOR WHOM THE SITUATED AT SOUTHOLD SURVET tS ,Am ON MtlS SF AF TO T'AM ME COMFW,ONERNEM& OF THE. AWm'P Atm L FM @P,.MO TO TWE MOT TWOMFOME Rs TOWN OF SOUTHOLD, SUFFOLK COUNTY, N.Y. OR Sl6SeoUENT OWNFRs SCALE I" = 40' DATE 1-27-2014 com OF THG aney NAP NOT Wwalo TFE ttw SIINYEYOR°S N®SEAL OR 7EMMM SEN.SWL NOT 9E oo 70 BE A'W TME CM FILED MAP No. 5187 DATE 10-9-1968 CERTIFIED ONLY TO: TAX MAP No.(REF ONLY) 1000-55-3-10 DISK 2014 PANETiA BANK HAROLD F.TRANCHON JR. P.C.RT TITLE INSURANCE COMPANY LAND SURVEYOR BRUCE A. PAYNE ASSOCIATES, INC. TITLE NO. 26134BS P.O. BOX 616 r 1866 WADING RIVER—MANOR RD.WADING RIVER, NEW YORK, 11792 N. .LIC.No.048992 631-929-4695 HAROLD F. TRANCHON JR. PENN.LIC.No_2115—E �- :olMS:SEP GRAM CONC. '. ! 4) "~w ¢�r y M AB rr r ED ✓ a\ rR COL]APE I: :::COGS Gm::; OC I'1 ' C„� — A Cllr. G1ROVlNID vA11E. e u:. „Vm if .......M.......�, V.E f s C: IF.AN°wa�,V'gV�o�as'�dV .�If�A�°V_II. ��'`*, "•.. 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