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Home My WebLink About11675-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southoid, N.Y. Certificate Of Occupancy No..Z.]! .4.0.7. ......... Date ..... J..a.n.u.a.~..y..3.: ................ 198..3. THIS CERTIFIES that the building ................................................ 90 Windjammer Drive Location of Property , 3 5.0 ............... U.a.r.b. 9 .p..L. 5. g .h.g.q .D.F.i.Ee' ........ ,S.qu, ,~ .hp.l.d' ... House No. Street Ham/et County Tax Map No. ] 000 Section . . . .0.7.1 ...... Block .. 0..2 ........... Lot . 02 0 Subdivision..H..aF.b. qr.. ~.i. gh. t.s..E.s t ..s ......Filed Map No..~..~.8.1., .Lot No..~.2...B ........ Section 2 conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .J .u.l.y., . 3.7 ....... , 198.0.. pursuant to which Building Permit No...~.1.6..7..5..g ............ dated .... ~a.y..1.9. ................. 19.8.2., 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 ......... ......... ~.private one-family dwelling.* The certificate isissnedtoJohn & Valerie Kramer ..................... ..................... of the aforesaid building. / Suffolk County Department of Health Approval .~.gr~.q=?.%..]~./.2.~./.8..2.,. ?. 9.bt .. ~..V..ill.a. UNDERWRITERS CERTIFICATE NO... N 583272 *First Floor Only Building Inspector Rev. 1/81 Fom~/ No. 2 Town or sOU~-"0,~' BUILDING DEPAR'TM£N't 'row~ SOUTH'OLD, N~: Y. BUILDING p, ERM!T (THIS PERMIT MUST BE KEPT ON TH.E PRE~ISE COMPLETION OF THE WORK AUTHORIZED) 11675 Z ........ ~......~'~...~,~.,......!....!i ................ ~.'.~,4..~.~"~...&.i~ ~o ......... ~..~..~..~...~........~.~.....~.'.~.: ............................ ................. ~ .................................... .: .............. ~ ........... , ........ :.~..¥...~.~..~ ....... ..~...~..~..~ ...... ~ ............ at p~emise~ located ot ~...~.~:~.~.~...~~ .... .... ......~.. ..................... .~., ....... ~Lot No. :.~.Z~ ......... pursuant to application dated . ..~.~.~ .................... ..., 1 , and ~ppmv~ by the Bu!l lng I~spector. F FORM NO. 6 TOWN OF $OUTHOLD Building Depar~men~ Town Hall Southoid, N.Y. 11977 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor ,czi~h the following; for new buiIdings or new use: 1. Final su~zey of property with accurate location of all buildings, property ~ines, streets, and unusual natural o; toeograohic features. 2.Fina~ approvai of Heaith Dept. of water supply and sewerage disposa --(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildines and "pre-existing" land uses: 1. Accurate sunzey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn 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,premises~ or other pertinent informa- tion required to prepare'a certificate. ' / ' C. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building . ./¢,~', ...... Old or Pre-existing Building(2;) ........ =/Vacant Land -' . ..... Hou~ No. ~ [ree( Ham/et wrier or Owners of Property .. . ..... ~ ............ Filed MapNo...: ....... LotNo, Permi~ No. .. Date of PBrmit . · · pplicant .. .~%¢.~ Health Dept. Approval . ~..~/.../~ ~...Labor Dept. Approval ..................... Request for Temporary Certificate ..................... Final Certificate ........ 1001071 THE NEW YORK BOARD OF FIRE UNDERWRITERS r~ EUREAU OF ELECTRICITY ~- 85 ,JOHN STREET, NEW YORK, NEW YORK 100~8 ..re November 15, 1982 171193-82 N,,. o. S, le N 58327 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the ab°ve application number in the pre.rises of Joh~ Kr~er, C/O WindJ~m%er Dr & Harbor LEs. Dr., Sout~ld, N.Y. in the followlng location; [] Basement [] 1st FI. ~] 2nd FI. Section Block Lot was exa,,i,wd on ~TOV~t~ 8, 1982 and found to be in compliance witb the requirements of this Board. FIXTURE I FIXTURES R[~NGE COOKING DECKS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT MVE~¥ AMT. K, W, AMT K. W ~ 35 34 30 35 1 7.1 i DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL EEC'PT. TIMEC/OCKS j BELL AMp TYPe EQUIP. 1~'2w 1.~3w 3.~3w 3~'4w NO O[E~,COND OF~C~/~g~iD NO, OF H/A. EG 1 200 CB x 1 4~0" Mogors :1-1 H.P. 1-G.F. L 1-~ke Detector 1-4.5 K.W. Ho~ Wa:er }]~ater 1-10.0 K.W. H~at PornV OVENS DISH WASHERS UNIT HEATERS MULTI-OUTLET ' __ NO, OF FEET C A. W, G. NO, OF NEUTRALS EXHAUST FANS AMA H P. F DIMMERS G & M ~leccrical P.O. Box 215 Southold, N.Y., 11971 Per__ ' This certificate must not be altered in any manner~ return to the office of the Board if incorrect Ins ecto~'s ma be identif'/' .... ~ h,..~.,~, ~~r cre~de~ntials~ COPY FO~ BUlL lNG DEPARTMENT, THIS COPY OF CERTIFII:ATE TERED IN ANY MANNER. -- FIELD I~S?EC~ION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY ~ODE Yo FINAL ADD COMMENTS: FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This app cation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new bui dngs 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters, 4. Commerc al buildings ndustrial buildings, Mu t pie Residences and s miler buildings and installa- tions, a certificate of Code compliance from the Arch tact or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April t957), Non.conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peopert¥ showing ail property lines, streets, buildings and unusual natural or topographic features. 2. Sworn 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 premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: I. Cart f cate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / land 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building u~ --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Jul~ ~/ 1984 Date ....................... ............ Vacant Land ............. L°cati°n°f Pr°perW/~u'~/~ i.~'+ /C) -~ L~Jv~ ~o~+~b'$treet .............. '~ ..... ; ................................. LO~ J J' Z-,'- ?_.~) V tC,,i '~'.~- Hamlet Owner or Owners of Prope~ ~. ~G. ~ County Tax Map No. 1000 Section ........ 07[ ....... Block ..... ~ ......... Lot .~Q,.[[.2~, ' Subdivision · . . ~ .................. Filed Map No ..... ~ .Lot No .............. Permit No ........... Date of Permit .......... Applicant ...~.~. Health Dept. Approval .................... Labor Dept. Approval Unde~riters Approval ........................ Planning B~ard Approw Request for Temporary Certificate ..................... Final Certificat~ Fee Submitted $ Construction on above de~ribed building~~~~~m~lati°ns' R~. 10-10-78 ~__~ · ·TOWN OF SOUT~O£O' ' ~J FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ · o ~...~..x .~.?~:.. · ~:-oZ...,,,.z..., m..,~,~m~.~.,,. ,u.... ~ ..... ,',~E^~ ~^KE ~O~ICE ,~ ~ou~ ~,,~,,on d~e~...~.~, l?~.. X.Z ......... ,~ ~0. for pe~it to con.ruer .... ~. ~1.~.. ~[~ .................... at ~o,~a~a~o.,07~c~o~..~.~X ...... ~,oc~ ..~ ...... ~o~ .~.~ ....... ~u~xv,~,~~%~.' ~,~ ~ ~o ................. ~o, ~... ~ .~. is returned herewith and disapproved on the follow~g ~ounds./~ ~ ............... .... W~a~. ~..~..~~. ~. ~z~~ .......... ....... ~.~~ ............................... ~ ......... ~ ...... ..... .~~...~..z~ :z~...~...~~ ..... BulldOg Inspector RV 1180 -,% lApp Southold Town Board o eals IVIAIN RImAD- ~BTATE RI'"IAD ~5 BI-IUTHgLD, L.I., N.Y. 11971 TELEPHONE (618) 785-180g APPEALS BOARD MEMBERS CHARLES GRIGONI$, JR. SERGE DOYEN, JR* ROBERT J. DOUGLASS GERARD ?. GOEHRINGER JOSEPH H. SAWICKI TO: FROM: DATE: SUBJECT: Mr. George H. Fisher, Senior Building Inspector Jerry Goehringer, Chairman, Board of Appeals February ~L, 1982 Appeal 2720, Application of John Kramer The board members have reviewed your recent correspondence dated February 10, 1982 and assume you are asking for a clarification of those items mentioned in your letter: Your Paragraph 2: Inasmuch as the board did not place a restric- tion in their 8/27/80 decision concerning the carport, it is suggested that an attached enclosed garage (rather than a carport) should be permitted provided it is not closer than 24'9" to Wind- jammer Drive and complies with all other rules and regulations of the building and zoning codes. Your Paragraph 3: Your interpretation is in acquiescence. February 10, 1982 Zoning Baard of Appeals Town Hall South~ld, NY 11971 Re: John Kramer ZBA #2720, 8/27/80 Gentlemen: I am calling your attention in case your. decision of the front yard set-back from Windjammer Drive was based on an open carport. Mr. Kramer now proposes the area of the carport to be an attached enclosed garage which will set 1'6" further back from the str®et line than the carport roof which you Mranted at 24'9". My interpretation of your decision is that no part of the building (enclosed or open) now or in the fuDure can be closer than 24'9" to Windjammer ~rive, 35 feet to Harbor Light Drive and 7'4" to the west side property line. I am awaiting your reply so I may issue a permit or disapprove the application again. Sincerely yours, George H. Fisher Senior BuSX~ing Inspector GHF:ec ? ? SUFFOLK CO. HEALTH DEPq H.S. NO,__ q 5.(::,~'O~'tO"~. - 1~0.0 ,e STATEMENT Of INT~ THE WATER SUPPLY AND SEW~ SYSTEMS FOR THIS RESI CONFORM TO THE STANDA SUFFOLK CO, DEPT. OF HEAL aPPLICANt I SUFFOLK COUNTY SERVICES - for CONSTRUCTION ONLY DATE: H. S. REF. NO,: APPROVED: ...... DEPT. APPF SUFFOLK CO. TAX MAP DESI DIST. SECT. BLOC~ IOCO O71 ~ OWNERS ADDRESS: ff.-,,7,..rtt40c. O, h7,\," /l~ DEED: L TEST HOLE SE RODERI K VAN T y/ pC LICENSED LAND SURVEYORS GREENPORT NEW YORK TOWN OF SOUTHOL~), NEW Yo~K ACTION OF THE ZONING BOAI%D OF APPEALS Appeal No. 2720 Application Dated July 22, 1980 ACTION OF THE ZONING BOARD OF APPEALS OF THE TOWN OF SOUTHOLD To Mr. John Kramer 6 Klm Avenue Smithtown, NY 11787 DATE .9./.1,0/.8,0 Appelant at a meeting of the Zoning Board of Appeals on August 27, was considered and the action indicated below was taken on your ( ) Request for variance due to lack of access to property (') Request for a special exception under the Zoning Ordinance (Xk Request for a variance to the Zoning Ordinance Art. III, ( ) 1980, the appeal Section 100-31 granted ( ) be de~ed pursuantto Article .................... Section .................... S~section .................... para~aph .................... of the Zoning Ordinance and the decision of the Building Inspector ( ) be reversed ( ) be co~irmed b~ause Public Hearing held 8/14/80 at 8:20 p.m. Application of John Kramer, 6 Kim Avenue, Smithtown, New York, for a Variance to the Zoning Ordinance, Article III, Section 100-31 for permission to construct one-family dwelling with insufficient frontyard set- backs and insufficient sideyard setback. Location of property: Corner of Windjammer Drive and Harbor Lights Drive, Southold, NY; bounded north by Harbor Lights Drive, west by Jones, south by Zic, east by Windjammer Drive; County Tax Map Item No. 1000-71-2-20. (SEE REVERSE SIDE) 2. VARIANCE. By resolution of the Board it was determined that (a) Strict application of the Ordinance (would) (woald not) produce practical hardship because (SEE REVERSE SIDE) difficulties or unnecessary (b) The hardship created (is) (is not) unique and (would) (would not) be shared by all properties alike in the immediate vicinity of this property and in the same use district because (sEE REVERSE SIDE) (c) The variance (does) (does not) observe the spirit of the Ordinance and (would) (SEE REVERSE SIDE) (would not) and therefore, it was fm'ther determined that the requested variance ( ) be granted ( that the previous decisions of the Building Inspector ( ) be confirmed ( ) be reversed. be denied and FORM ZB4 ZONING BOARD OF APPEALS A~ter investigation and personal inspection, the Board f~nds that.applicant proposes to con~tructlan one-family dwelling with an insufficient s!deyard set- back (on the west side) of approximately 7!4" and with an insufficient frontyard setback (east si~e) of! approximately 24'9" at its nearest point a~d with an insufficient frontyard setback (north sideI of approxi- mately 35'. The Board finds existing on t~e premises a brick garden wall, for which applicant p~oposes to use for gardening. Because of the uniqueness ofl the parcel having two frontyards (corner lot), the Board feals that applicant's request is not unreasonable, t~at th~ relief requested is not substantial in relation t0 the ~ode requirements, and detriment to adjoining p~opert;ies would not be created. Accordingly, the Board agrees with the reasonings of applicant. The Board finds the circumstances present ini this case are unique, and strict ~ppll~ation of~the olrdinance would produce practical diff~cultles or unnecessary hardship. The Board believes the granting~of a Variance in this case will not change the characteriof thle neigh- borhood and will observe the spirit of thei zoninlg ordi- nance. On motion by Mr. Grigonis, seconded ~y Mr Goehringer, it was RESOLVED, that John Kramer be grante~ a Va,fiance to the Zoning Ordinance, Article III, Section! 100-311 as 1 ~a~in Appeal No. 2720, and SUBJECT TO THE FOL- LO~ITION: That the area within the brick gardeh wall:' existing on the premises not be used for any furthe~ cons!truction, without the express prior written approvaliof thle Board of Appeals. Location of property: Corner of Harbor Li~ghts and Windjammer Drives, Southold, New York; boubded n:orth by Harbor Lights Drive, west by Jones, south ~y Zlq, east by Windjammer Drive; County Tax Map Item No.l 1000-171-2-20. Vote of the Board: Ayes: Messrs. Grl~onis,i Tuthill and Goehringer. Absent were: Messr. Douglass a:nd Doyen. APPROVED RECEIVED AND FILED BY SO HO TOW HOU /.' Town Clerk, Town o! $outhold FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAL~ SOUTHOLD, N.Y. 11971 TEL.: 765-1802 _., ....... Approved (Building Inspector) INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of ProPerty must be drawn on the diagram which is part of this appli- cation. 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 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 whatever until a Certificate of Occupancy 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 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 lo--oval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, builCdfig cod~ hoj,~ng code,/Ji~d regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections.//.///~/ /- / ((SignaBlre of applicant, or name, if a corporation) (Mailing a~ldress of applicant) × State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner or premises .: .-~-~...~:~ n..~c.. ?..~.~.~..~..~.,..q-m ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No. Electrician's License Other Trade's License No ...................... 1. Locatioja of land on which propo~se, cl work will be done..~..~.~ ~.~... O.¢..i7[t~t'?. ~ .~.~..~. l~ .~t .7~ ..'~..~t ~ ,~, · c?,0 U..,tr~¢.//;~,"~Y)~./" ~y/,'" ,, ~ ~ , ,--. ,. ' ......... House Number - Street ............. h~n'l~; .... }' .......... County Tax Map No. 1000 Section .... ~..'~. / ....... Block.. (~. ~-~ .......... Lot..(~.,~.~..'. ......... Subdivision ..................................... 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 ... L,,{/~. -.~..~..~.?:../~...,/C-.~:. ?..&.'.~. ....................................... b. Intended use and occupancy ............ 7 ..... ' ......................................... 3. Nature 6fwork (check which applicable): ~qew Building ..... ~.. 'Addition · Alteration .......... o~al I Demolition Oth r Work Repair ~ .............. Rem .......................... e ............... ~ (Description) 4. Estimated Cost. ~ .... .~. S7/.~.~ ~ ......... Fee ............ ' .......................... I --~.~ , (to be paid on filing this application) 5. If dwellin number of dwellin u' its i / Number of clwellin~ units cm each fluor g, g n .... ~ ................. ~, ............................. If garage, number of cars .. ~, ~-.~. ~' 6. If business, commercial or mixed .'occupan~ ' y, specify, nature and extent of each type of use ..................... 7. D,menslonsofexisringstructures~ if any' iront~'r''~e//~:J~ Rear . De th ............ Height ............... mumUer of St les .69.~?~TP.Q .~..~.. ~...~.fft..~,%...~i .r~).~. ~..g:~. ............ Dimensions of same structure with alterat(ons or addit¥ons: Front ................. Rear .................. De,pth ..................... i · He~ght~ ......... I ............ Number of Stories ...................... 8. Dimensions of entire new construction: F~ont . .~..O. (~v/s] Rear .. ~..O. - .~/x. · · Depth .~ o ........... Height N tuber of Stdries / "./.' "~ 9. Size of!et: Front .... /.O.t~.(..! ...... i... Rear ..../~o/ .............. Depth ./.~4.~.~ ............... 10. Date of.Purchase .... ~q~'P'/.7.~ .... i .......... Name of Former Owner CO~.or.~ ................. 1 1. Zone or use district in which premises are ~ituated .... ~.7.. ~.~de~.~.~,~.7,~-e.. .............................. 12. Does prgposed construction violate any z~ning law, ordinance or regulation: . 13. Will lot be regraded .. ~.~1~ &.. i ...... ~ i ........... Will excess fill be removed from premises: Yes 14. Name of Owner of premlses'2~.~r~, b~r~q~'O*.t':... Address ~/~..q,~rfiv'ra~z.~. Phone No.~'~q.~.y.$. Name of Architect ~. ~ .0~..m.l.~.~..~...; ......... Address ~.I~..1~..g'.fl~ffi~.Phone No ................. Name of Contractor . .~ ~.~./~r.,q~,~,.~ ......... Address (~. ~.~ra rr,.~?a~ ~ Phone No.~.~ ~'/~..~.~'tl , ' ! ~ PLOT DIAGRAM Locate clearly and distinctly all buildings!, whether existing or proposed, . and, indicate all set-back dimensions from property lines. Give street and block humber o~ description according to deed, and show street names and indicate whether interior or corner lot. i ~ ' STATE OF NEgl YORK., . ,.~ ~ ~ COUNTY OF~O~..Z~..~q.A. & .... ~' ~ .................................... i ............. being duly sworn, depose8 and says that he is the applic~t :(Name of individual s~gning contrgct) above named. ; ~ He is the : ~ % i (~ontractor, agent, Corporate officer, etc.) ' ' ' of said owner or owners, ~d is duly auto, ed to perform or have perfo~ed the said work ~d to m~e and file this applicarion; ~hat all statements contained ~ ~his application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fort Sworn to before me this d, h in the application filed therewith. '.~..~f~ ....... ,19 .~. ............... q SUFFOLK CO. HEALTH DEPT. APPROVAL h.S. NO. STATEMENT OF INTEN'~ THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS For THIS RESIDENCE ,CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK SERVICES - FOR CONSTRUCTION ONLY DATE: H. S. REF. NO.: APPROVED: I COUNTY DEPT. OF HEALTH APPROVAL OF SUFFOLK CO. TAx MAP DIST. SECT. BLOCK PCL. DEED: L. TEST HOLE ' I I STAMP SEAL '%. q A SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT Of INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (S} APPLICANT SUFFOLK SERVICES - FOR CONSTRUCTION ONLY DATE: i i H. S. REF. NO.: APPROVED: COUNTY DEFT. OF HEALTH APPROVAL OF SUFFOLK CO. TAX MAP DESIGNATION: OWNERS ADDRESS: TE~T, HOLE ~0+ LtCE~ED LAND SURVEYORS GREEN~RT NEW YORK SEAL ¸5. ~ 0 ~ P -l-' SC;F~:SE~C0. hE~TH OEP'r. APPROV^~ . . H.S. NO, , ~STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DIS~SAL ,o ......... J .... SYSTEMS FOR THIS RESIDENCE WI LL ~ CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT ~ SUFFOLK CouNTY DEPT. OF HEALTH ~ SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO., APPROVED: SUFFOLK GO. TAX MAP DESIGNATION: SEAL VAN T~YL, GREEN~RT NEW YORK ~' ~ ~ · ' ' I SUFFOLK CO. HEALTH DEPT, AF~ROVAL ~ . ~ ~ ' ~ , tO- .~0- -/4 [ ~' ' ~ STATEMENT ~ INTE~ ~ , ~- [~ O~ ~~ . · . THE WATER~LY AND S~AGE DI~SAL r~ C' ~~ ~ - ~'~ ~ ~ ~' -- 1~.O ~o ~ SYSTE~ FOR THIS RESIDENCE WILL f,' -; ' -:~ ~ *~ ~ ~x - ~ ~ ,~ ~: , -CO~ORM TO THE STANDARDS OF ~T~,' ~ .... ~, ~.~ ~J~ ~ ~l~ . . , ~ ~ ' ~ ~ I IS ~PAAm, AND ON ~;~, ~. , ' , ' ,, ' ........ ,L-'"' ,>::",,,,',,'? ..... : ....... ' ,1 - ,, ,:,,' ,,' ..... ,'~},, * "; }:.,,' ' -; ~ OCCUPANCY OR USE D~ UNLAWFUL WtT:~ CERTIFICATE OF OCCUPANCY APPR/OVED AS NOTED_ ~ NOTIFY gUILDING D~P~.~VTMENT AT 7~5-1502 9 AM TO 4 DM FOR THE FOLLOWING INSPECTIONS: l. FOUNDATION - TWO RE(~)UIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. ]NSULAT!ON 4. FINAL COFIqTPq I"TIqN MUST BE COMPECTTE FOR C O ALL CONSTRIJCT1ON SHALL N~EFT THE REQUIREMENTS OF THE N ¥ STATE CONSTRUCTION & EN:P~v CODES NOT RESPONSIBLE FmR DESIGN OR CONSTRUCTION ERRORS cj 0