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HomeMy WebLinkAbout44577-Z �gUFFOt,�COG Town of Southold 6/27/2020 0 . P.O.Box 1179 _ S 53095 Main Rd Southold,New York 11971 - CERTIFICATE OF OCCUPANCY No: 41213 Date: 6/27/2020 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1376 Lighthouse Rd, Southold SCTM#: 473889 Sec/Block/Lot: 50.-5-5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/31/2019 pursuant to.which Building Permit No. 44577 dated 1/7/2020 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: finshed basement and bilco door addition to an existing one family dwelling as applied for. The certificate is issued to Burgos,Mary&Bourssard,Camille of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44577 6/23/2020 PLUMBERS CERTIFICATION DATED C\ f) N �'\ n t riz d M1gnature TOWN OF SOUTHOLD BUILDING DEPARTMENT y z TOWN CLERK'S OFFICE oy • 4� SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 44577 Date: 1/7/2020 Permission is hereby granted to: Burgos, Mary 560 Riverside Dr Apt 12K New York, NY 10027 To: construct additions and alterations to existing single-family dwelling as applied for. At premises located at: 1376 Lighthouse Rd, Southold SCTM # 473889 Sec/Block/Lot# 50.-5-5 Pursuant to application dated 12/31/2019 and approved by the Building Inspector. To expire on 7/8/2021. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $492.80 CO -RESIDENTIAL $50.00 Total: $542.80 B ' _ 'n pector 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 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$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.Q /?0l fry New Construction: Old or Pre-existing Building: (check one) Location of Property: 1.3?ro �!4 h -�64 Sp_ koa,4 ��oy o�� House No. Street 99 ll p Hamlet Owner or Owners of Property: c�Q q vn 1 1 1�2 B�0 U S 5 �e2 Suffolk County Tax Map No 1000, Section ® Block Lot U�� Subdivision Filed Map. Lot: Permit No. 4 q 57 Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Signt e Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) 3,, iPfjCk55'A&I> s 1 e residing at t371, U S'kl K oU.�o QU (Print property owner's name) (Mailing Address) do hereby authorize Do U -�A A c. kc-Q viv (Agent) to apply on my behalf to the Southold Building Department. PU;�� Z"T 21 L'-'x cem&v 20 l (Owner's Signature) (Date) M R SUP605 6M,IIE &,W5SAR-ID (Print Owner's Name) SO Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G Q sean.deviina-town.southold.n us Southold,NY 11971-0959 y COW N' BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Mary Burgos Address: 1376 Lighthouse Rd City,Southold st: NY Zip: 11971 Building Permit#: 44577 section: 50 Block- 5 Lot 5 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA- G&S Electric License No: 578-ME SITE DETAILS Office Use Only Residential X Indoor X Basement X Service Only Commerical Outdoor 1st Floor Pool New Renovation X 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph X Heat Duplec Recpt 12 Ceiling Fixtures 4 HID Fixtures Service 3 ph Hot Water Gas GFCI Recpt Wall Fixtures Smoke Detectors Main Panel 200A A/C Condenser Single Recpt Recessed Fixtures 12 CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 9 Twist Lock Exit Fixtures LI Combo SD/CO 2 Other Equipment: 20A ARC-2, 15A ARC- 2 Notes. Basement Renovation Inspector Signature: '� Date: June 23, 2020 p 9 �- S Devlin-Cert Electrical Compliance Form.xls OF SObTyO --— - # # TOWN OF SOUTHOLD-BUILDING DEPT. courrty ' 765-1802 INSPECTION- , M/FOUNDATION 1ST Fo�n9s [ ] ROUGH PL13G. ` r [ ] UNDATION 2ND = [ ] INSULATIOWCAULKING--" [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE &-CHIMNEY j ] FIRE SAFETY INSPECTION [ ] =FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) _ [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: q�� � .pir�► (l1� IN-- I �. DATE INSPECTORKq Im -2 OF SOUlHp6 J 7 l 7 # TOWN OF SUTHOLD BUILDING DEPT. �yco 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] -FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE 77 C 24C) INSPECTOR - SOUTy� * TOWN OF SOUTHOLD BUILDING-DEPT. coum, 765-1802 INSPECTION [ ] FOUNDATION 1ST [/ROUH PLBG. FOUNDATION 2ND [ ATION/CAULKING FRAMING /STRAPPING [ [ ] FIREPLACE & CHIMNEY, [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: rl\v DATE INSPECTOR OF SOUTyOIo qL157-7 I'3 76 L: 14 H T H6 U cS c '42-'D f TOWN OF SOUTHOLD BUILDING DEPT. MumN 765-1602 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION- [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [� ELECTRICAL (FINAL) r [ ] CODE VIOLATION [ ] PRE C/O -bA-9MtiJT POWD REMARKS: DATE 2 2d INSPECTOR �" FIELD INSPECTION REPORT -DATE COMMENTS FOUNDATION (1ST) -------------------------------------- ' �C FOUNDATION (2ND) n c,� V%JA o14Vz a a y ROUGH FRAMING& PLUMBING y 6 -57 INSULATION PER N. Y. y STATE ENERGY CODE tr� -- v FINAL �r r AD44IONAL COMMENTS � � �0 •S ,�o q 4 , Z rn � H �O z x . d , r Sr l;ivision Filed Map No. Lot d i 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy a 14 IQ Q-5+c(e"Vc@ b. Intended use and occupancy S..!tj I kie i e n,Ce_ 3. Nature of work(check which applicable):New Building Addition P"' Alteration \ Repair Removal Demolition Other Workj3cLjV_Men+ 1 ✓l tS 1. 441 c0 4. Estimated Co (�pJ006,DFee O (Description) i (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 ,�AA � 6. If business,commercial or mixed occupancy,specify nature and extent of each'type of use. /y 7. Dimensions-of existing structures,if any:Front S-- 4 Rear �� - Depth a Height' a 3 -Number Number of Stories' Z. Dimensio�ofsame structure with alteration k�o�additions: Front Rear Depth �`ck Height a - `, tNumber of Stories 8. Dimensions of entire new construction:Front Rear 7 r{ �?`''Depths Height i]P W N[6mbeir of Stories 9.' Size of lot:Front - l 3'g' Rear 1701, Depth 4!57 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises ares 12.Does proposed construction violate any zoning laky,ordinance-or=regulation?YES NO 13.Will lot be re-graded?YES NOy Will excess fill bexemoved from premises?YES NO' 14.Names of Owner of premises Alk gRc� Address 131(0 L`8 Phone No." Nameof°AAit66t 7%5, "' Address ' ' Phode'No - 'Naiiie of Contractor ' Address''"``'` "Phone No: 15 a.Is this property,within 100 feet of a tidal wetland or a freshwater'ii etland?*YES N_0 *IF YES„SQUTHOLD_TOWI BUST EES&D.E;C�PE1iMlT ;MAY.BE-REQUIRED. - b.Is this property,within 300;feet of,a tidal;wetland?*YDS , NO *IF YES,D.E.C.PERMITS MAYBE REQUIRED = 16.-P,rovide 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. Are there any covenants'and restrictions with respect to this property?*YES NO *IF YES,PROVIDE•A COPY. STATE OF NEW YORK)” COUNTY OFS" rtibeing duly swom;deposes and says that(s)he is.the apnitaap��Y L. D,1nIY�R (Name of individual signing contract)above named L•�`. ,, HA NOTARY PUBLIC,ATATP OF NEIN YORK (S)He is the �( - -- N0.01 bW6306900 (Contractor,Agent,Corporate Officer,etc.) QUALIFIED 11-N-810_FFOLK COUNTY COMMISSION EXPIRES JUNE 30,0O)Xg,-_ 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 tlus 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. Swom to before me thi day o dviaaALA 20AQ No ary Publ c Signature Vplicant TOWN OF�SOUTHOLD BUILDING PERMIT APPLICATION CHETKLIS`P BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 /' Planning Board approval FAX: (631)765-9502 1 `1 '" Survey Southoldtownny.gov PERMIT•NO. ✓ Check Septic Form NYSD.EC Trustees C O Application Flood Permit Examined 20 Siiigle&Separate ' Truss Identification Form Storm-Water Assessment Form, nContact: Approved I_' "20 �U Mail to ' Disapproved a/c; f � Phone lal 76 7 Ex�rrtibn; Building Inspector. >TEC 3 1 '2019 •--=� " . , , . , APPLICATION-FOR BUIIDING PERMIT Date !`o�Z — C� ,20 (of INSTRUCTIONS a This-application MUST be completely filled in b"y 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. , - , ^ . • ' '" •,. ') Y . -,; , f.Every building permit shalf expire if the work authorized has not commenced within 12 months after 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,anew permit shall be required- APPLICATION equiredAPPLICATION IS HEREBY MADE'to the Buildmg Department'for the issuance of a Building Pemut pursuant to the Building Zone Ordinance of the Town of Southold,Suffofk County,New fork,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as-fierein described:The' applicant agrees to comply with all applicable laws,ordinances,building'code,Eousing code,and regulations;and to admit authorized inspectors on premises and in building for necessary inspections �p ��C.�pa►/�ut �� A-a rn-Q-s �G (Signature of applicant or name,ifa corporation) t m e L&-4g, 5o,vao ld wt-71 (Mailing address of applicant) . , St to whether app 'cant is owner,lessee,agent,�achitect,engineer,general contractor,electrician,plumber,or builder Name of owner of premises m 0, U u FL a S &Gti_fVL 1 +,O U SSS 6 P_ :j. _. .• (As on•the tax roll or latest deed) f lican ,1 'cid r on, afore of duly authorized officer (Name,an_dtitle of c orate officer Builders License No. i PIumbers License No. Electricians License No. Other Trade's License No. 1. Lt tion land on which propgsed work will be done J /' A House Number _Street Hamlet County Tax Map No. 1000 Section 0 Block 0s Lot 0 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX:(631)765-9502 `1 Survey Southoldtownny.gov PERMIT NO. ✓ Check Septic Form NYSDEC Trustees C O Application Flood Permit Examined 20 Single&Separate Truss Identification Form Storm-Water Assessment Form Contact: Approved 20 Mail to Disapproved a/c IPhone_ Expiation, 20 _ Building Inspector DEC 3 1 2019 APPLICATION FOR BUILDING PERMIT Date 20 1�i 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 £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 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 premises and in building for necessary inspections. 4AC,C_6rJ&U, 4- 4,6 MO-s :rlic (Signature of applicant or name,if a corporation) (Mailing address of applicant) State whether app]'cant is owner,lessee,agent, chitect,engineer,general contractor,electrician,plumber or builder Name of owner of premises M0,P.%4 iD u a. c7 S o_ A 1t© V SS 6-p_ (As on the tax roll or latest deed) f lica i jC7 kron, ature of duly authorized officer (Name and title of c orate officer Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. L c tion of land on which proposed work wive don • t' / 1 PJ7Ce Li ,k-i'k®cis Roe- "6_& House Number Street Hamlet County Tax Map No. 1000 Section 0 Block 0 Lot Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy u [4- RQ-6 /fie Ce b. Intended use and occupancy i kl'g 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work 13cx-M ril e n+ "+✓1 t�A%I eO (Description) 4. Estimated Cost DOo,O® 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 �A 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. /`J 7. Dimensions of existing structures,if any:Front Y9 7 G Rear `G — Depth Height 'ala Number of Stories a Dimension o same structure with alteration or additions: Front `��' Rear Depth Height -Z-6 Number of Stories : 8. Dimensions of entire new construction:Front -7— Z Rear 7—�{ 'Depth Height ByP W G cQ2 Number of Stories 9. Size of lot:Front 1 Rear N Depth J 10.Date of Purchase Name of Former Owner 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 1` Will excess fill be removed from premises?YES NO 14.Names of Owner of premises 9'4Q � ae Lress 13')�0 L-'d Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. / v V 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 OFS0 z v being duly sworn,deposes and says that(s)he is the ap }�ap ��L. ©w��� (Name of individual signing contract)above named, NOTARY PUBLIC,STATE OF NEW YORK (S)He is the #-1( l�� - -- NO,01 DW6306900 IJ (Contractor,Agent,Corporate Officer,etc.) LTA FOLK COUNT' COMMISSION EXPIRES JUNE 30,2.�Mg-_ 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 Swore me thi day o Q/ 20 4fy1'F*0'q '—f - Id r)14 (�J//Jgx't 0-49z=�7-� No ary Public Signature plicant guEFQ1xC BUILDING DEPARTMENT- Electrical Inspector �O TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Raacl 4'PO Box 1179" ' ; Southold, New York 11971-0959" Telephone (631) 765-1802 -nFAX°\(631)^^II 5-990 20 roger. chert�town.southold.nV j 3 APPLICATION FOR ELECTRICAL INSPECTIO 'EQUESTED-BY:._.. .__ . _. _... . .- _..__.._ .._.. .__..._.. .._ _............. Dater oz� Company Name: L,q C---, Name: W. 4�;v..A e-24�c License No.:. �E2,V---6-- email: Cc ,=Qo L . C.,vK Address: x 0-,,5 .C-o, � Phone No.: P s� / JOB SITE INFORMATION: (All information Required) Name: v e z- G^p S Address: o L-ra Cross Street: Phone No.: Bldg.Permit#: _ � .- 7 7 email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) {2�',rj0 �,fA710 Circle All That Apply: Is job ready for inspection?: YES / NO Rough Iri Final Do you need a Temp Certificate?: YES NO Issued On Temp Information: (All information required). Service Size 1 Ph 3 Ph Size: A #Meters Old Meter# New Service-Fire Reconnect-Flood Reconnect- Service Reconnected - Underground -Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: (a1 ,t�-i� -� �v-���,'�, — ( � ®u�c� PAYMENT DUE WITH APPLICATION G( Request for Inspection Focm.As PERMIT# Address: Switches Outlets Illt'1 �1 �I G F I's Surface I Sconces HH s IX1 UC Lts Fans Fridge HW Exhaust Oven Dryer Smokes DW Service (/vv Carbon Micro Generator Combo I Cooktop Transfer AC AH Mini Special: Comments S�cFQ� BUILDING DEPARTMENT - Electrical Inspector �p�q, jam'✓ ,. �C� TOWN OF SOUTHOLD U. Town Hail Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 �•--� •;:� -=�..� � ' a Telephone (631) 765-1802 - FAX (631) 53 9020. .JJ Ol roger.rich ertna town.southc - nV APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: - - - - Date- Company Name: License No.: ) V — email- s /� V� C�— ��o Z Address- v Phone No-- S l� Y s� JOB SITE INFORMATION: (All Information Required) Name- (� C) O S Address: Cross Street: Phone No.: Bldg.Permit#- 1__/Y _577 email: Tax Map District: 1000 Section: ,SO Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) (2 pj0 A Circle All That Apply: Is job ready for inspection?: OYES / NO Roux- ghIn Final Do you need a Temp Certificate?: YES O Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A # Meters Old Meter# New Service - Fire Reconnect- Flood Reconnect - Service Reconnected - Underground - Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: 'J Arte Ul-) CIO, I U r> PAYMENT DUE WITH APPLICATION Gl Request for Inspection Form.xls 1 I _ The water supply and Sewage disposa] SOUNDO U N D V I E W AVE. system for this residence will con- t! G I form to the standard of the Suffolk ( VA�LANT ) County Department of Health Se,-vice. N/O/F LI ND .tJlK ,� • sef N.48°34'40E. 170.74 ` � % 49.9 i 96. L'�'�Ifi1I C(/ 5109 65'utility easement o SURVEY FOR so o MARK FINNE a PATTI FINNE • ° a AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY , N. Y. rn Z6S 1000 - 50 - 05 - 05 W AREA = 25, Q: FT. � SCALE I"= 30' 8 6 TEST HOLE � tFEB. 4, 6651.6 APR. 4, 1986® a EKMRES TWO YEARS FROM CERTIFIED TO Pe;i$E OF APPROVAL Jr• C%jro � a�r ! COMMONWEALTH LAND TITLE _ INSURANCE COMPANY o i lu TITLE NO. 6624 - 328 - S p MARK FINNE a a a a PATTf FINNE I<-�,�,,,,s,� s;,,� 4 G 5' ufillt easement �•= � � �et ' o SUFFO"K COUI:TY DuARTMENT OF 14EALTH SERVICES N.48`34'40E. $] `�K � 30' WIDE ROW I .0k M APR II 198s 320.00' Ls {{�fev� gu=,AapRD`IAL OF CCii�$Tp::CT`nn F S. 4@'34 138.00 5Q '2pE TEST HOLE �ng•�g�v°C' y' 4.86 (ELEV. 51.6 ) _ G� SC DEPT.OF i j 0� —5a_7 HEALTH SERVICES C 5,utility easement �� ' f �C�..��n••� NEW te -Tandy O� ` N' O/F WAC Se ' �c loom VACANT Me.A�'® S� • rocks tal!c � f LAN Z11;Y9C YOY aw9er _ N.Y.S • LIC.N0. 49668 ELEVATIONS ARE REFERENCED TO ASSUMED DATUM PECONIC SURVEYORS & ENGINEERS, P.C. ( 516),765 - 5020 P. O. BOX 909 MAIN ROAD SOUTHOLD,N.Y. 11971 vtl� 0-1 ------ on 16 P7 J� Ic o R lco C '00 A,? dco ,Al" + 7� 0 vs e a�d 6- tli-il C, I j t,JY SCALE* APPROVED BY: DRAWN By DATE LREVISED rk re,C-� DRAWING 14UMIIER