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HomeMy WebLinkAbout11588-z FORM N0.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. C@fFIflCat@ ~ OCCU~t1C)/ No.. Z 1 1332..... _ Date ,December 10 . . . . . 1982, THIS CERTIFIES that the building . Location of Property .1,Q00,,,,,,,,,,,, BgBChwood, Lane,,,,,,,,,,,,,,,~Sputllold,,,,, Houar No. Street Nsmist County Tax Map No. 1000 Section ..Q70.......Block O..........Lot ....05.9.. , . Subdivision...Southwood,,,,,,,,,,,,,,,,,,Filed Map No.21,41,,,,LotNo. 5?........... conforms substantially to the Application for Building Permit heretofore filed in this office dated M a r c h..9 , , , , 19 8? pursuant to which Building Permit No. ? ? 5 6 B , Z, , , , , , , , , , , dated a r c h. 23 , , , . 19 8 ~ ,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 . a private oLe-family dxelling. The certificate is issued to JOHN FARRELL,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, roamer, /same ortenena of the aforesaid building. Suffolk CountyDeparUnentofHealthApproval . 1.1,-S0-8q,, 1,2/9t8~~,Robt,, A.,Vi,l,lip, P.E. UNDERWRITERS CERTIFICATE NO......... N 580224 Building Inspector Rev. 1/a1 e } S: Fora; xo~. a ~ ~ ` TOWN OFS~1lLTH04~1.:i . ; BUILDING bE~ARTME~JT', ~ " TOWN HALL SOUTH'OLD, Ns Y, s` • BUILDING iP~tRMIT j< 4 (THIS PERMIT MUST BE KEPT ON THE PRElv1,IS UNTIL FALL COMPLETION OF THE WORK'AUTHORI~ED). t a k p,? N~' 11588 Z Date 19..A.x?~ Perrnission,is hereby granted to: ° ; .....:...f.~.~.r,,.:'~.?.. . ........~%:....~:rri t at p~'emises locoted at .~~i..C~.'.~J.........~~~:~~+~'~~~t~..i'.~~?: County Talc Map No. 1000 'Section " ~locl~ ~ fat No. irMJ.,,..., pursuant td application dated 19.....$., and approved by the • ~ ~ Builc~fng Inspector. ~ , i ~"ee~.~K ..T..C f ' 6 SE ig. - f F ' a'- ~ S n i B i ding; nspectof' -jam ~ a ' ~ it _ ' Rev X6/30%80 ~ . g ~ ~ , ~ . _ i S.E c+~' $.,xe.~ e , ~ am.,~r$~ a 3~i , xf^z. -k; o ~ - - • FORiYi N0. 6 TOWN OF SOUTHOLD 8uiiding Department • Town Hall Southold, iv.Y. 7 i97 i APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspac• for with the following; for new buildings or new use: 1. Final surrey of property with accurate location of all buildings, property lines, streets, and unusual n aural or tooocraohic features. • 2. Final zoproval of Health Dent. of water supply and szwerage disposal-(S-9 form or squall. 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildirgs and instal{a- tions, acertificate of Code compliance from the Architect or Engineer responsible'for the building. 5. Suomi[ Planning Board approval of completed site plan requirements v~here applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing al{ property lines, streets, buildings and unusual natural or topographic features. 2. Scrorn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premiszs, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy 55.00 2. Certii;cate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date II- ~"'L.~ ~ 6'1"~ . . Ne•.v Building .Old or`P~re,-existing Building{?S) . _ ~ rVacant Land Location of Property ~ s~...._ .YL=A"~'.1~~!~? W.h S.,FI:.+tt • • .~o v TyiO , , . . , . House No. Sneer Hamlet .~-w Owner or Owners of Property ,l'~ a C'"~!~T.~:~ti'~" ........................p......... . County Tax Map eN~. 1000 Section Block O Lot ...r'~..! . Subdivision ....cam'" u V ~1'4~"?!~'u'.? .....[.~..G....Filed i~rtap No. Z'' ..Lot No. .~i Permit No. ~.~rD, ?.~Z Dare of Per.T . 1'.L?~.! ~A„rlicart !;'~'U M`:. @ Health Dept. Approval ........................Labor gapt. Approval . Underwriters Approval ........................Planning Board Approval ....r, • Request for Temporary Certificate . ......Final Certificate - vd Fee Submitted S ? ~ Construction on above described building and cermit melee s all a pl~cableyodes and reeulations. Rev. 10.10.78 ~ ~ 4"'-'• if (~.~(~Z. 1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS %78 QCtiC7b@T 21t 19$2 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 70038 ~q Date Applicateon No. on file 171937-82 A 1 ~ ~ ~ y THIS CERTIFIES THAT FBI m only the electrical equipment as descrihed below and introduced by the applicant rtomed on the above application numher in the premises of John Flarrell, S/S ~eact~od Ta. 100° B/0 Mittens Ia., Southold, N.Y. in the following location, Basement LJ Ist Fl. ? 2nd Fl. Section Block Lot was examined on Ch`tObe~ 14 t 19$2 and found to be in corrtpliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCENT fLUORESCENT mexcuav VAPOR AMT. K W AMT. K' W AMi. K.W AMT. K. W AMT H P i 36 4l. 20 36 d •.6.87 1 7.S 1 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMi. K W. Oll H. P. GAS H. P. AMi. NO. A W. G AMT. AMP AMi. AMPS TRANS, pMi. H P SYSTEMS pMT. WAiiS NO.OF FEET 3 F 1 3 600 ~ SERVICE DISCONNECT NO.Of S E R V I C E AMT AMP TYPE METER L 4W I 3W 3 9 3W 3,e" 4W NO. OF CC COND A. W G. NO Of NI-LEG A W G NO OF NEUTRALS A W G EQUIP. PER A" OF CC. GOND Of HbtEG OF NEUTRAL 1 200 CB s 1 2J0 1 1/0 OTHER APPARATUS: A1CTCorB s 1-1 IiE' 1-G.F.C:T. 1-Slnokc TJeteetor _ L'C~'L%`L`~ -C'o'l Ituland ~1~tric C:o. Y.O. Box 143 g v~ MEtt~tUlCFCt IV.Ir. t 11952 *242°L'' - GENERAL M1}NnG~ER ~ 11 Per r' This certificate must not be altered in any manner; return To }he office of The Board if incorrect. Inspectors may be iden}ified by ;their creden}iaJ' - COPY FOR BUI?~DIN6 DEPARTM,EN'~. THIS COPY gF CERTl~FI~,AT NI~1 NpT ,BE TERED 1?y' ANY MANNER. ~ , ~.._.._a._._ FIELD INSP~y;^TI~N DAT COMN.~~P;TS: H _ _ C~- ~ H FOUNDATION (1st) + ~~~y-n Q q~ ~ - f wT.\ FOUNDATION (2nd) / _ ~ 2. C o.~ ~ ~ f ~ ~ ~ f'~ ~D~ /ids `CJt ~ l~ ~ z ROUGH FRAME & ~ls~~ ~El~ ~ - ~d°~ ~ ~ o PLUMBING ~ ~ Q ~ 2 F_'.~ ~ " 3, y m ~ INSULATION PER N. Y. y STATE ENERGY CODE Q~ x / ~ ~ ~.L-(~_ _ FINAL o~ z o` z ~ ADDITIONAL COMMENTS: EJ /J _ ~i/~/~Z. .~~p.~_ -7-~ t~e-Gl U I.va,i.A.wtl ~~A""~ cs.~,5 ~„L+~ti i. dN'S'Z l,U Y ILOrr.,.,i lu- G/.bU "''1 i-~ 'F- ~'-R 4 C ~ t'M uB'., a H H O _ z - - - - a r l y C x ~ ~ ~ to I it FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL FileN(oJ D~ayt/e~ lya~-C~t ~ 199. Y. ti-~.......... L PLEASE TAKE NOTICE that your pplication date~d,/.l'T ~.~'~rf/ 19 . for permit to construct ..G!.'{E..pp!.~~..n?!~ ....~rf/~!.". ~ll!?i~.' at/,,/ Location of Property S~rS... <7E'4t~.!7~' .pOd. , ~1~~7 LAC......... /',~~Q!v House No. Street ••\~~e Namlet County Tax M No. 1000 Section 7d...... Block ..../.~J....... Lot Subdivision~~!7!y UrloG Filed Map No. . ZI. Lot No. J • Z . is returned herewith and disapproved on the following grounds S~~l.~ ~r~.. ~h~~~.rh,~~.~~ ~93~...,~?in ~ su/.~TG.. off- ~~G~~~'.,... . ...G'o.c/~' ~cce.~ . . Building Inspector RV t/80 r 4; ~ . ~.r' s s. _ 3a, . ~ I'kRM7T NO c~ k NgW~YgRk STATE hEPARf`MF.MT OF GNVIRt)NMRNTn4 ~QNSERV~Ti4N ~ ~ ~ r` r';,``: R "~..~~~°Qi~~,,l~,t , t- . -...,....~.r» , PERMIT UNDER THE ENVIRONMENTAL CONSERVATION LAW _ ' ~ A~I7ICLE 1g, (Proteotign of Water) ARTICLE;~SJ,(~Lidal WPlhgg4l° > ~ + Gr.,;. . - ~ ARTICLE 24, (Freshwater Wetlands) ~ ARTICLE 36, (Canatruetipg,;ie<fJood Na'zarQ ArRas) > '<a ~ ' FERMIT ISSUED'TO i Gany'.~zarln.~. "4.$sen -gon J`ah~, and' A2in~nu Fahneee° ~ ~ ~ . r a ' ADDRESS OF PERMITTEE s a P.O. Bax 38, Ma,~n Road, Ma:t~.tuck, New Yanh ? 1746 ~ ~ LOCATION OF PROJECT (Section of stream, tidalwetiand, dam, building) ~ ~ ~ t"~, Gaoae Cntzeh DESCRIPTION OF PROJECT - ~ ' Cona~icuat one t;ami-Cy dweR:R.i.rag a rhin.i,mum a6 75' X.andrti~ucd o{ ~h.~ .t~.da.e wa.~and 6~.~~ aict~ a ya.tem a rni,n,Cmum a>S 100' ,~andwafid. a y zhe ~ida2 tuet2and kaunda~,'y. , COMMUNITY NAME (City, Town, Village) ~ TOWN ' SatLtiwkd Soct~iw~d COUNTY FIA COMMUNITY NO. DAM NO. PERMiT EXPIRAT{DN,QATj:, Sfl~y {a.Q~2 SQ ~K111~k2fL,~Q 'o"". GENERAL CONpITIONS 1. The permittee shall file in the office of the appropriate Regional 8. That the State of Ne~w~ York shaih is no case bd fiabie,fpt any dama8$~' Permit Administrator, a notice of intention to commence work at least 4g or injury to the structure or wprk herein authorized vrpich may 6e caused py oF'' hours in advance of the time of commencement and shall also ngtify him result from future operations-undertaken by the State fdr"the cdnsatya~~ipd„qt,'+? promptly in wrRing of the completion of the work. Improvement of navlgatlan, or for of her purposes, .and ng~claim or ,~Ight tp~ compensation shalt accrue frpm any such damage. 2. The permitted work shall be subiect to inspsctlon by an authorized ~ - representatfve of the De artment of Environmental Consmvatlon who may 9, That if the des la of Ughts~and Si oats on any Work tj reb afithonz ~WWr P p Y B bi y ¢N.-''.' order the work suspended if the public interest so requires. is hot otherwise provided fgr.4y IaAV, sup$ lights and ¢ignala•es"may ~q prp', scribed by the United States~Coagt Guard shall be. instelled~~,ahd m¢intained"^, 3. ~ As a condition of the issuance of this permit, the- applicant has so- - , cdpted expressly, by the execution of the application, the full legal respon, bV and at the expense ql the owner, - sibility Por all damages, direct or indirect, of whatever nature, and by whom- 10, All work carried put.'undar 1hi9 ,p!krmihshall be ~Pa~fpymed pl a~'`pf';~":~ ;`"-,ever suffered, arising out o[ the Project described herein and has agreed to dance with established engendering practiCb'aM in a'worfFinanlike mangat indemnify and sav¢ harmless the State ffom suits, actions, damages and it If granted under Articles ~1,4 rot 2S'tlie' Department ep~edVes the ngfl4~ ,costs of every name and description resulting from toe said project. to reconsider this appfoval'at any time anpaftet due. potipg +aqd heaNhg tgF h: ' 4. Any material dYedged Ire the prosACUtlon of the work herein permitted continue, rescind or mod(fy this parmtt in such a manner a6 may ke tpppd to=, tt, shalt be temoved evenly, without leaving large refuse plies, ridges atross the be just and equitebte. If upon the ek piratlon or reYocattnn of this patpli(l ,thy, a', bad of the waterway or flood plain or deep holes that may~have a tendency-ta .mad Ulcation o} the wetland iereby'•authg4lzed Id.5 nqt beeh'compla"t~dJ,thy'.,)i l _ Eause inj u'ry to nav)gable channels or to the banks of the waterway, applicant shall, wiihoUt ezpegse to the State, and 1o such extept and in ~sucp'~'"; s ~ 5. Any material to be deposited or dumbed under this permit, either in time and manner as the DepaYkment bf Environmental Conservation; maq r'dr~uirep ; remove stint any pnrtign of the~uncompt¢ted structate,gr felt and r¢stdre ~thy,~ . the waterway or on shore above high-water mark, shall be deposited or dumped seta to its 'former condition. NP claim shalt be made'agalhst ihe~State; yf New: : ' at the IgcalitV shown on the drawing hereto attached, and, if so prescribed York on account ofany such removal or alteration. ~ `t - ~ thereon, within or behind a good and substantial bulkhead or bulkheads, such i as will prevent escape of the material into the waterway. 1Z. This permit shall not be con@trueC~~as cdnveying'to the appHianl sh'y':.. ' right to traspase upon the, lands or interf¢re with'tha' npariaq'r(ghls gt'olhel'a,': ' 6. There shall be no unreasonable interference with navigation by the to perform the permited wark~or as authocgai ng the impa)rmenq'df any fi'gM@yk. N~brk fierein authorized. title or interest in real p) Personal propg~tY-held or vested in d~pers~th'npt a' ;7, That if future operations by the State of New York reQuire an altera('iod Party to the-permit. ? In the Dosition of thq structure or work herein authorizeU, ur ii, in the opinion 73, The pormittee Is responsl4le for, optaining any -other perpY(ts, A~', ; i of the DeDartme nt of Environmental Conservation it shall cause unreasonable provals, lands, easements and rights•o6w¢y which may',be requirad~',fgr fhls.~" Obstruction to the free pavlgdtion of said waters or flood flaws ar ondanger project. ~ ~ -'~s:~~' k the health, safety or wRlfura of rho IwoPlo of rho 5tato, ar loss or dusinirllun ` ? ' of the natural resources of the State, the owner may-be ordered by the Depart- 74, If granted under Attlc(e 36, Ihis,PgTmit la granted agl¢Ly~on ipe bash i ment to remove of alter tfie structural work, abstractions, or hazards caused of the requirements of Article 36 of the ~nvironma4tat Cgnser4attgn t,aw.aTtd~'' p thereby without expense to the State; and f4 upon the expiration or revocation Part 500 Of 6 NYCRR (Construction in F`lopd;Plain kraal paving Spetia~ Fionil° of this permit, the structure, fill, excavation; or pt her mod ifieation of the Hazards - Ouilding Permitsy and in no way sign'rfies lest toe proieet wHl ilC?J, watercourse here4y authorized shall not be completed, the owners shall, free from flooding. i.~ without expense to the State, and to such eztent and in such time and manner ~ ~ 15, ay acceptance of thig ,permit the permittee agrees ~th~,t the pgrnlit~."~ As the Department of Environmental Canservatlon may requiro, remove all or is contingam peon strict complial7ap wile the 'spacTat condit)gns 6n ihb', any portion of the uncompleted structure or fill and reslme to Its former reverse side. ~ ~ ~ ~ ' ~ -condition the navigable and flood capacity of the watercourse. No claim shall f,„ be made against the-State of New York on account of any such removal or ' alteration. ~ a.;7 " ~ a~ 45.20.4 (4!751 (SEE REVERSE SIDE) ~ ~ ' i fF s f 'c- - Sit ]M f 1. -.y.,...„ r wr. a =o, k - ...a Y n fly. ~ ~ il'.~ SPECIAL CONpIT10N5 I6. ThelLe ehaP.e 6e na dis,tw.bance to vegetut~.on or topography 50' .Candward o6 xJEe tcda.C we~Zand boundah.y. il. Thence ahaC£ 6e na b-i.Y.e broElght to .the pro,{ect a.i,te wuthout prior pellaLtde.con o b thi.a o 6 .ice. PERMIT ISSUE DATE PERMIT ADMINISTRATOR ADDRESS Q- ~y-~s w~ ~ ~ ~ ? Q a? w~ ~ ~ ~ A V ,a v, ~ y CD ~ ~ L_.1 ~ U u ~ ~ y ~ ~ 4 ~ ~ C. o ~ ~ ~ cc cv co ~ W ~ ~ ~ O • C Q ~ r~/ A O a+ ~ ~ Q d. m o a ~ ~ 4 ~ a. H ~C ~ ~ ~ x rt a. v o „ C1 . • ~ ~ ~ ~ ~ ti a ~ a~ ~ ~ ~ y,. r- ~ ~ F. ~ ~ ~ x' ti V 0 ~ ~ Fyn rt ~y .y ~ O C!y V ~ 00 oe r? r,; R: N ° ~ s , o ~ a ~ y ~ ~ d ~ H a ,4, ~ N~. E. a CFO, (Y~ ~3 c, ~ - F v, r. c °I71.,M;, ~ ~d.~- FORM N0. 1 ' " TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, PI.Y. 11971 ' TEL.: 765-1802 j~ / Examined ~ 19C/.~ Application No./ . Approved ~ .~.y"t'~'.W ~ I Permit No. ,t. ~c~.~C/. Disapproved a/c U (Bui ding Inspector) APPLICATION FOR BUILDING PERMIT Date ...3 .~f..........., 1 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 strer or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apF cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc raJ of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whale or in part for any purpose whatever until a Certificate of Occupan 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 t Bui]ding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demoljtion, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housirrgcode;Jand regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature/of applicant, or name, if a corOporation) ` ~ok, 1111.7ov"f!-l~o~.d?..!~.."~..!~.1~!..... (Maili;rg address of applicant) ' State whe±her applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Nvne of owner of premises ......./"I~, ..tit ~ ~L~~'i'~" (as cn the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporapte officer) Builder's License No. ~ ~ 1 . Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done. . /o o u 'S ~ ~j Ple'-'1~~e H W o oea ~A-+J 1.t' ~ ~ 't ~ ~1~0 ~..a~ House Number ''j Street Hamlet QQ County Tax Map No. 1000/S/action O......... Block ~.U Lot S .i . Subdivision ~~~7~~~ Filed Map No. Lot . (Name) 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 occupancy ~ ~`.1 ~S . [ , 1. Nature of work (check whicb a plicable): New Building Addition Alteration . P Repair Rento~al Demolition Other Work . , ~ ~ (Description) QQ ~ r ' Estimated Cost...........1~ Fee .1.3~............,......T........... !f dwell (to be paid on filing this application) ing, nwnber of dwelling units j. ~ Number of dwelling units on each floor . If garage, munber of cars . . If business, commercial or mixed occupa cy, specify nature and extent of each type of use . r. Dimensions of existing stnictures, if any: Front Rear Depth " . . Ilciglit Nutttbcr o£St ries . Dimensions of same stricture with altera dons or additions: Front Rear ...C . Depth tr..........'.. Heigh ........Number of Stories . i. DllttetlSlonS of entire new constr}tction: ~ront . , Rear ..~r0'nt...... Depth . ,'Lu!n bcr of St ries ~ Fleioht 'unt,........... Rear . ~ Depth .Z'~? 7. Size of lot: E'ront q 7..' ~ , , . . Date of Purchase ..................Name of Former Owner ...........i . I . Zone or use district in which premises ar situated . Does proposed construction vi`o1ate any z ring law, ordinance or regulation: a4 3. 1i'il! lot; be regraded T~ , ...........Will excess fill be removed from premises: Yes 3. Name of Ovmer of premises+ .e,N . Addressk?oo?>•,'16,u(~..+1'~. n ~q C " ~e~.Y. ..,hone No. Name of Architect ~y Address., ...Phone No. . Name of Contractor .1H....K--o+`? .........Address . (U!..~. 9'!!hr!~!+. Phone No.~°.r~.'~'~'1?.. . PLOT DIAGRAM Locate Clearly and distinctly all', building ,whether existing or proposed, and, indicate all set-back dimensions from ;operty lines. Give street and block number ~r description according to deed, and show street names and indicate whether tcrior or corner lot. TATE OF NEB RK S.S OUNI'Y O • . • • -'C7 . being duly sworn, deposes and says that he is the applicant ' me of individual sigijing c nt ct) Love named. ' eisl.he Contractor agent, corporate officer, etc.) f said owner or owners, and is duly a o ize erform or have performed the said work and to make and file this lplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed iri the manner set for h ut the application filed therewith. worn to before~me tt(his otary PuUlic . County ~vr ~ ,ANN NEVILLE ~~v NOTAR I PUBLIC. State of Naw York ~ - - - ~ ' ' ' ' ~ ~ ' ' ' ' ~ ' ~ ~ ~ ~ ~ ~ - ~ ~ ~ ~ ~ ~ ~ ~ ' ' ~ ~ ' ' i (Signature of applicant) i ~ No. 52-8125850, Sutfolk County Ter Expiles March 30, 19..~~ i SUFFOLK CO. HEALTH DEPT. APPROVAL H S. NO. SQ^87 vacartfj ` ~~~~~r ~ C'VAN~~~ ~ C o< ~ ~~~cN ~ _ i C'~E - (N~~p OF ~-'t~K,E1G 7-`/ STATEMENT OF INTENT s THE WATER SUPPLY AND SEWAGE DISPOSAL - l SU~v~-Y~L- FOrG D~~ I~~~' CS~ ' / SVSFEMS FOR THIS RESIDENCE WILL .N,\ ~ ~µd~ ~5 P ~ q ~ ~ ^ / CONFORM TO THE STANDARD6 OF THE µAf~Epgr~ ` O ('T t ~l _ ~ 1 ~ F- ~ t 'fJ l ~ r -1 ( ? ~ . ! F--~LG ~~L_... ~ - ~ Pa s \ A"T SUFFOLK CO. DEPT. OF HEALTH SERVICES. _ W~ 1 r - . q,., lgs. SOC.ITNC~LD 151 APrUCANT ~ c ~ ~7 0 \ SLJFF=f~LLC (SJUNTY N.Y. ' ho. 1 SUFFOLK COUNTY DEPT. OF HEALTH ~ ? C6 ~ ~ SERVICES - FOR APPROVAL OF ~ ~ N ~ CONSTRUCTION ONLY _ _ O p ~ DATE: !`~JO~I ~ 6 \ H. 5. REF. NO.: A d- O ~ \cu'y~~b ! APPROVED: - 1 / ~f9,~~ F `j ~ I (53~ , SUFFOLK CO. TAX MAP DESfQM1fTWN: N~i !o/~ ~ m ~vacarTh~ ~ Scale SO~~I'~ pIST. SECT. 9LOCK PCL. J ~Z , - % ~ Ar~cx 24, 750 s ffi 1000 070 OIO 39 ( u = rrlortumc~trf OWNERS ADDRESS: RAtDE ~5 0 i ~ .sro6es®d~ ~ "5 L / ~ 82 F4rY/a~v6n F8411e[/t VA'/[>' pA~E E+ ~ CeSfR~ j ,boy Yl tG~~l PpOLS ~ ~ Woot~~urY, a/. Y, !l797 O ~ '~~E~r ~ d~,~k'~~` 1~ ~ ~ F_levcrf-io.ES refer ~o mean 3ev level. ~ ~~~p ~ ~ ` ~ EXP>,AVATION MISPECTION REQU~ED DEEP: L. 6988 las cu ~ , t j a ~ - DHAUIIIORQFD ALTERATIO7FpR AOWTIOM J C~ JO 7X15 EURVET 6 A WOlATM7N OI Nofe r Lof numbers shown r ~o ~Lo+ t9) ~ ~ y ~ SECTION 7709 d 7XE NFW TOM! STATI IDEILASbM LAW. l "Mai r~ f Sou~fTwa~od, "filed rn ScrJ~OlL humus : ce aAs M /Vo. 2N9! . _ bN soR1EE a 7MIS suRVEr Rw XoT EEAMXc GO.._ larks off d~7 JIIE WO uev[roR•s IXR® ELA[ a \ ~ gwouED sFAL sx,RU XoT r CONlID~p ' A~/ ]p 1 ~ ~ JO Mi A VALID TMIF CORT. ' e `Of R~ / / CUMANIFEE MIDIGTED~ HEREON SMAII RUN a ~rI_ • ~ i rOCNr} OKT TO TNF 9ERSON FOR WHOM TX[ WVET 26 . ff// ~ F[ IEL/ARFD, AND ON XIE REIIAIF TO 111E - ~%P 6 ~ ~~Q ~ I 1 ~ nnE COM.A}1T, GOVERNMENFAI AGENCY AND / ~ IEEOR/G NQIlUOON [IETED X:Rp1, ANp he$ ~ TO 7XE ASRRiNEES OE THE U:NDING IISTI~ Q~ ' I• p TUTION. QMMNTEEE ARE NW IRAMWERAKI o-' ! .TL ~ r v 'O ADONIONAI INE111U1gN5 OR EUIf~(tI1FN higk ~j ~ l~ wNFRS. ! 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F f'nR C. n ALL COMST Ri iCl'ION S'!AI L r`.^`ET ' . - ~ THE REpUIR~_P^.Er ITS OF TFJO PJ V STATE CONSTRUCTION & ENCP ;Y ' ~ _ - ~ CODES NOT Rf_SPONSICI4 FOR ~,F~ ~acW y,, DESIGN OR CONSTRUCTION ERRORS PPS A ) L i/ <n~ No. 35496 k`~V' ' sfG FBGFC5510NFk